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RECENT    PUBLICATIONS 

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By  G.  ELLIOT  SMITH.  M.A.,  F.R.C.P.,  F.R.S.,  Dean  of  the  Faculty  of  Med- 
icine and  Professor  of  Anatomy  in  the  University  of  Manchester;  and  T.  M. 
PEAR.  B.Sc,  Lecturer  in  Experimental  Psychology  in  the  University  of  Man- 
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"One  of  the  ailments  of  soldiers  that  may  be  called  a  novelty  of  the  pres- 
ent war  is  treated  more  exhaustively  than  ever  before  in  this  work." 

— Army  and  Navy  Journal. 
MEDICAL   DISEASES   OF  THE   WAR 

By  ARTHUR  F.  HURST,  M.A.,  M.D.  (Oxon.),  F.R.C.P.,  Temporary  Major, 
R.A.M.C.;  Physician  and  Neurologist  to  Guy's  Hospital.  Second  Edition,  re- 
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war  nephritis,  have  been  largely  rewritten." — From  the  Preface. 

THE  ORIGIN,  SYMPTOMS,  PATHOLOGY,  TREATMENT  AND 
PROHPYLAXIS  OF  TOXIC  JAUNDICE,  OBSERVED  IN  MU- 
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Being  a  discussion  by  the  Sections  of  Medicine,  Pathology,  and  Epidemiology 
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j/JlC  SltYVCV 

MILITARY  HYGIENE  AND   SANITATION 

By  Lieut.-Colonel  CHARLES  H.  MELVILLE.   M.B.  (Edin.),  D.P.H.,  Royal 
Army  Medical  Corps.     With  13  diagrams.     Svo.     S4.80  net. 
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.   .  ;  tiseful  to  army  officers  responsible  for  the  health  of  soldiers  and  the 
sanitation  of  camps  in  any  part  of  the  world." — Engineering  News. 

THE    SANITARY    OFFICER'S    HANDBOOK    OF    PRACTICAL 
HYGIENE 

By  C.  F.  WANHILL,  Major,  R.A.M.C,  L.R.C.P.,  Assistant  Professor  of 
Hygiene,  Royal  Army  Medical  College;  and  W.  W.  O.  BEVERIDGE,  Major, 
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beverages,  ventilation,  sewerage,  bacteriology,  etc.  .  .  .  An  interesting  feature 
is  that  the  book  is  interleaved,  giving  opportunity  for  notes  and  comments 
by  each  individual  user." — The  American  Physical  Education  Review. 

LONGMANS,    GREEN    &    CO.,  New  York 


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WELFARE    AND    HOUSING:     A   Practical    Record    of    War-Time 
Management 

By  J.  E.  HUTTON,  Manager  of  the  Labor  and  Catering  Department  of  Vickers, 
Limited;  Member  of  the  Food  Investigation  Committee  of  the  Ministry  of 
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INDUSTRIAL  EFFICIENCY:   A  Comparative  Study  of  the  Industrial 
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BY  ARTHUR  SHADWELL,  M.A.     New  Edition.     $2.25  net. 
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giving  material  for  the  economics  of  the  world's  chief  industrial  activities." 

— The  World's  Work. 

THE  CONTROL  OF  THE  DRINK  TRADE:  A  Contribution  to  National 
Efficiency,  1915-1917 

By  HENRY  CARTER,  a  Member  of  the  Central  Control  Board  (Liquor 
Traffic).  With  a  Preface  by  LORD  D'ABERNON,  Chairman  of  the  Board. 
With  Diagrams  and  Illustrations.     8vo.     $2.50  net. 

"It  is  a  splendid  record  of  one  of  the  greatest  social  experiments  ever 
tried  in  the  United  Kingdom." — British  Weekly. 

THE  WHEAT  PROBLEM:   Based  on  Remarks  Made  in  the  Presi- 
dential Address  to  the  British  Association  at  Bristol  in  1898 

Revised,  with  an  answer  to  various  critics,  by  SIR  WILLIAM  CROOKES, 
O.M.,  F.R.S.  Third  Edition.  With  Preface  and  Additional  Chapter,  bringing 
the  Statistical  Information  Up  to  date,  and  a  Chapter  on  Future  Wheat  Sup- 
plies, by  Sir  R.  HENRY  REW,  K.C.B.,  and  an  Introduction  by  LORD 
RHONDDA.     Crown  8vo.     $1.25  net. 

A  warning  by  Professor  Crookes  issued  in  1898,  that  England  was  in 
danger  from  a  shortening  of  her  wheat  supply,  is  reproduced  in  this  book, 
together  with  a  review  of  conditions  in  19 16,  showing  how  it  has  been 
justified.  It  presents  not  only  an  English  problem  but  treats  of  the  world 
problem. 

"Of  the  vital  interest  and  importance  of  the  problem  at  the  present 
time  there  can  be  no  two  opinions.     The  book  should  be  read  by  everyone." 

~~~  1\  a  t  tt  y  & 

ENGLISH   FARMING,   PAST  AND   PRESENT 

By  ROWLAND  E.  PROTHERO,  M.P.,  President  of  the  Board  of  Agriculture. 

Second  Edition,  with  a  new  Preface.     8vo.     $2.50  net. 

"Not  only  a  good  historical  record,  but — read  aright — one  of  the  best 
guides  to  the  highest  and  best  agricultural  political  economies  that  we  have 
in  any  language,  and  it  comes  at  a  moment  when  sound  guidance  is  a  very 
pressing  need." — Land  Agents'  Record. 

LONGMANS,    GREEN    &    CO.,  New  York 


ALCOHOL 

ITS  ACTION  ON  THE 
HUMAN   MECHANISM 


ALCOHOL : 


ITS  ACTION  ON  THE 
HUMAN  ORGANISM. 


NEW   YORK: 

LONGMANS,     GREEN      AND      CO. 

FOURTH    AVENUE    AND    30TH    STREET 

1918 


2,0-  -b?  *  >1 


IN  November,  191 6,  the  Centrab  Control  Board  (Liquor 
Traffic),  appointed  an  Advisory  Committee  "to  consider 
the  conditions  affecting  the  physiological  action  of  alcohol, 
and  more  particularly  the  effects  on  health  and  industrial 
efficiency  produced  by  the  consumption  of  beverages  of 
various  alcoholic  strengths,  with  special  reference  to  the 
recent  Orders  of  the  Central  Control  Board,  and  further 
to  plan  out  and  direct  such  investigations  as  may  appear 
desirable  with  a  view  to  obtaining  more  exact  data  on 
this  and  cognate  questions." 

The  Members  of  the  Committee  were  as  follows  :— 

Lord  D'Abernon,  G.C.M.G.  (Chairman). 

Chairman  of  the  Central  Control  Board  (Liquor  Traffic). 

vSir  George  Newman,  K.C.B.,  M.D.  (Vice-Chairman). 
Principal  Medical  Officer  to  the  Board  of  Education. 
Member  of  the  Central  Control  Board  (Liquor  Traffic). 

Piofessor  A.  R.  Cushny,  M.D.,  F.R.S.,  Professor  of 
Pharmacology  at  University  College,  London. 

H.  H.  Dale,  M.D.,  F.R.S.,  Head  of  the  Department  ot 
Bio-chemistry  and  Pharmacology  under  the  Medical 
Research  Committee,  National  Health  Insurance. 


to 


M.  Greenwood,  M.R.C.S.,  Statistician  to  the  Lister 
Institute  of  Preventive  Medicne,  and  Reader  in  Medical 
Statistics  in  the  University  of  London. 


11 

W.  McDougai.1,,  M.B.,  F.R.S.,  Reader  in  Mental  Philosophy 
in  the  University  of  Oxford,  and  Fellow  of  Corpus 
Christi  College,  Oxford. 

F.  W.  MoTT,  M.D.,  F.R.S.,'  Pathologist  to  the  London 
County  Asylums ;  Consulting  Physician  to  Charing 
Cross  Hospital. 

Professor  C.  S.  Sherrington,  M.D.,  F.R.S.,  Waynflete 
Professor  of  Physiology  in  the  University  of  Oxford,  and 
Fellow  of  Magdalen  College,  Oxford. 

W.  C.  Sullivan,  M.D.,  Medical  Superintendent  of  the 
Rampton  State  Asylum  for  Criminal  Lunatics. 

The  Committee  have  now  prepared  as  a  provisional 
basis  for  further  research  the  following  review  of  the 
existing  state  of  scientific  knowledge  regarding  the 
action  of  alcohol  on  the  human  organism.  The  con- 
clusions represent  the  unanimous  judgment  of  the 
Committee. 

December,  19 17. 


PREFACE 

By  IyORD  D'Abernon. 

The  part  played  by  alcohol  in  social,  industrial  and 
economic  life  is  so  considerable  that  knowledge  of  its 
action  on  the  human  body  might  reasonably  have  been 
expected  to  be  full  and  precise.  The  total  amount  of 
money  devoted  to  the  purchase  of  alcohol  by  the  inhabi- 
tants of  these  islands  is  nearly  50  per  cent,  greater  than 
the  traffic  receipts  of  the  whole  railway  system,  including 
both  goods  and  passengers ;  it  is  more  than  double  the 
expenditure  on  bread,  and  more  than  equal  to  the 
expenditure  on  meat :  before  the  war  it  was  approxi- 
mately equal  to  the  total  revenue  of  the  State,  and  was 
more  than  eight  times  the  total  amount  required  for 
interest  on  the  National  Debt.  Apart  from  the  economic 
aspect,  it  is  admitted  by  all  parties  that  the  misuse  of 
alcohol  exercises  a  considerable  influence  on  health  and 
longevity,  and  it  is  contended  by  one  large  section  of 
opinion  that  it  is  a  main  cause  of  crime  and  poverty. 
The  ill  effect  on  individual  and  national  efficiency  of 
excessive  indulgence  in  alcohol  is  not  disputed.  In 
many  other  countries  alcohol  plays  as  great,  and  in  some 
a  greater  part.  It  is  remarkable,  therefore,  that,  through- 
out the  world,  lack  of  exact  knowledge  still  prevails 
about  the  action  of  alcohol  on  the  human  system.  No 
authoritative  scientific  work  gives  or  seeks  to  give  the 
required  information ;  on  many  important  points,  which 
it  is  requisite  to  elucidate  in  order  to  regulate  the  proper 
and  legitimate  use   of  alcoholic   beverages,  and  also  to 


IV 

furnish  practical  guidance  to  the  individual  consumer, 
little  of  substantial  value  has  been  published  in  a  form 
accessible  to  the  general  reader. 

The  absence  of  any  authoritative  work  is  perhaps 
partly  accounted  for  by  the  fact  that  many  of  the 
essential  data  are  not  known  even  to  science.  A  large 
amount  of  laborious  experiment  has,  indeed,  been  directed 
to  certain  aspects  of  the  action  of  alcohol ;  but  the  choice 
of  questions  for  investigation  has  often  been  determined 
by  the  ease  with  which  they  could  be  put  to  the  test,  or 
by  their  bearing  on  some  theoretical  controversy,  rather 
than  by  their  intrinsic  and  practical  importance.  There 
are  many  points  concerning  the  use  of  alcohol  in  daily 
life  on  which  research  has  been  so  inadequate  that 
knowledge  with  regard  to  them  is  both  scanty  and 
imperfect. 

It  may  facilitate  the  understanding  of  what  is  meant 
by  deficiencies,  or  lacunse,  in  scientific  knowledge  regard- 
ing alcohol,  if  I  state  some  of  the  points,  many  of 
considerable  importance,  as  to  which  no  data,  or  only 
very  inadequate  data,  exist.  I  have  adopted  the  interro- 
gative form  in  order  to  give  greater  precision  and 
clearness.1 

(i.)  In  what  way,  and  to  what  extent,  if  at  all,  do 
solutions  of  ethyl  alcohol  in  water,  as  commonly  used 
in  laboratory  experiments,  differ  in  their  action  on  the 
nervous  system  from  ordinary  alcoholic  beverages  of 
corresponding  strength,  such  as  beer,  wines,  or  spirits  ? 

1  Experiments  directed  to  answering  the  first  five  questions 
in  the  above  list  have  been  carried  out  during  the  past  year  by 
Dr.  Edward  Mellanby. 

Some  very  suggestive  results  have  already  been  communi- 
cated to  the  Committee  while  this  book  has  been  passing  through 
the  press,  but  a  final  judgment  as  to  their  significance  may  be 
reserved  until  the  full  Report  of  the  research  is  ready  for 
publication. 


V 

(ii.)  Are  there  any  differences  in  inebriating  action, 
and  if  so  what  differences,  between  the  several  sorts  of 
alcoholic  liquors  when  taken  in  doses  of  equivalent 
alcoholic  strength  ?  Does  the  drunkenness  caused  by 
beer  or  wine  differ  in  character  from  that  caused  by 
spirits  ? 

(iii.)  Is  the  effect  on  the  nervous  system  of  a  given 
dose  of  alcohol  modified  when  it  is  administered  in  a 
combination  of  alcoholic  liquors  ?  Does  mixing  drinks 
tend  to  produce  drunkenness  ? 

(iv.)  Does  the  greater  or  less  degree  of  dilution  in 
which  it  is  administered  modify  the  immediate  action 
of  a  given  dose  of  alcohol  on  the  nervous  system  ?  If 
so,  why  and  how  ? 

(v.)  In  what  respect  and  through  what  mode  of 
influence,  if  at  all,  is  the  action  of  alcohol  affected  by 
its  administration  with  food  ?  To  what  extent  does  its 
action  vary  with  the  particular  foods  taken,  e.g.  fats  and 
sugar  ?  Will  a  given  dose  of  alcohol  have  a  greater  or 
lesser  effect  on  nervous  functions  when  taken  w7ith  a 
meal  than  when  taken  on  an  empty  stomach  ?  If  there 
is  any  difference,  it  is  due  to  a  difference  in  the  rate 
of  absorption,  or  is  it  to  be  explained  otherwise,  and 
if  so,  how  ? 

(vi.)  Does  the  presence  of  fatigue  modify  the  effect  of 
alcohol  on  the  performance  of  skilled  movements  ? 

(vii.)  How  does  climate  affect  the  amount  of  alcohol 
that  can  be  taken  without  injury  to  health  ?  Is  alcohol 
less  injurious  in  moist  climates  than  in  dry  climates  ? 

(viii.)  To  what  extent  is  the  development  of  chronic 
alcoholism  dependent  on  lesions  of  the  stomach  brought 
about  by  the  directly  injurious  action  of  the  alcoholic 
beverages  on  the  mucous  membrane  ? 

(ix.)  Does  the  feeling  of  increased  cheerfulness  induced 
by  alcohol  favour  the  resistance  of  the  organism  to 
adverse  physical  influences,  such  as  cold  ?. 


VI 

To  none  of  these  questions  is  it  now  possible  to  obtain 
a  precise  and  authoritative  answer.  Yet  it  is  of  vital 
importance  that  knowledge  regarding  the  points  involved 
should  be  full  and  accurate.  There  are  many  further 
gaps  in  our  knowledge.  For  instance,  there  is  an  almost 
entire  absence  of  reliable  data  regarding  the  psychology 
of  the  drunkard,  though  adequate  information  on  this 
point  is  obviously  essential  to  devising  rational  methods 
for  the  treatment  of  the  inebriate.  Little  is  known  of 
the  progress  of  the  drinker  from  occasional  excess  to 
chronic  alcoholism.  Are  the  occasional  drinker  and  the 
habitual  drunkard  two  distinct  types,  or  is  the  former 
an  early  stage  of  the  latter  ? 

Further,  there  is  a  deplorable  deficiency  of  reliable 
statistical  ''ata  concerning  alcoholic  disease  and  mortality. 
This  deficiency  is  due  in  part  to  the  unsatisfactory 
system  of  certifying  the  causes  of  death,  and  also  in 
some  measure  to  absence  of  clinical  investigation  regard- 
ing the  extent  of  the  influence  of  alcoholism  in  bringing 
about  the  diseases  associated  with  excessive  drinking. 
This  explanation  does  not,  however,  cover  all  the  facts, 
for  even  in  the  case  of  diseases  of  unequivocally  alcoholic 
origin,  such,  for  instance,  as  delirium  tremens,  no  general 
statistical  records  have  hitherto  been  kept,  save  in  isolated 
localities. 

The  usual  explanation  given  to  account  for  this  position 
is  that  the  subject  is  both  difficult  and  ungrateful.  It  is 
held  to  be  difficult  because  its  investigation  has  to 
overcome  obstacles  even  greater  than  those  encountered 
in  all  experimental  research  which  seeks  to  derive  guid- 
ance as  to  the  action  of  drugs  in  the  human  body  from 
the  behaviour  of  the  same  drugs  in  the  test-tube,  or  from 
their  effect  on  animals,  and  this  for  a  simple  reason.  The 
action  of  alcohol  on  the  higher  centres  of  the  brain — the 
action  of  special  importance  in  relation  to  the  ordinary  use 
of  the  alcoholic  liquors — can  only  be  elucidated  by  investi- 


v:l 

gation  in  man,  and  the  results  of  such  investigations,  even 
when  they  can  be  objectively  determined,  are  necessarily 
of  very  doubtful  interpretation,  owing  to  the  complexity 
of  the  nervous  functions  in  question,  and  the  degree  in 
which  they  may  be  affected  by  the  idea  on  the  part  of 
the  subject  that  a  given  result  is  desired,  or  by  bias 
felt  by  the  subject  as  to  the  result  of  the  experiment. 

This  special  difficulty  is  enhanced  by  the  fact  that  it  is 
extremely  hard  to  disguise  the  presence  of  alcohol  when 
given  in  the  doses  necessary  for  experimental  purposes, 
and  that  it  is  no  less  hard  to  counterfeit  it  satisfactorily 
in  control  doses. 

Complication  in  arriving  at  the  true  effect  of  alcohol 
on  performance  further  arises  from  the  fact  that  while 
alcohol  gives  the  drinker  the  impression  that  he  has 
performed  the  allotted  task  with  unusual  facility  and 
success,  impartial  and  objective  examination  of  the  per- 
formance shows — almost  invariably  in  cases  where  the 
higher  faculties  are  concerned — that  both  accuracy  and 
regularity  have  fallen  below  the  normal  standard.  Self 
satisfaction  has  been  increased,  but  neither  skill  nor 
power. 

The  extreme  caution  which  these  considerations  impose 
upon  students  detracts  from  the  brilliancy  and  certainty  ol 
any  deduction  from  experiments,  and  tends  therefore  to 
render  research  less  attractive  than  in  other  directions. 

The  second  alleged  reason  is  that  alcohol  is  an  ungrate- 
ful subject.  The  origin  of  this  opinion  may  be  traced 
to  the  general  belief  that  most  people  who  are  interested 
in  the  subject  are  already  partisans  on  the  one  side  or  the 
other,  and  that  no  body  of  impartial  opinion  exists  which 
is  ready  to  be  guided  by  scientific  inquiry.  The  majority 
of  those  who  would  give  any  attention  to  original  work 
on  the  subject  would  do  so,  less  to  gain  knowledge,  than 
to  find  arms  and  arguments  to  support  their  preconceived 
opinion. 


Vlll 

Whether  or  not  these  reasons  are  a  true  and  com- 
plete explanation,  there  can  be  no  doubt  as  to  the  fact 
itself,  viz.  that  knowledge  on  the  subject  of  the  action 
of  alcohol  is  inadequate  to  the  needs  and  importance 
of  the  question.  In  view  of  this  situation,  the  Central 
Control  Board  appointed  a  special  Committee  to  consider 
the  subject  from  a  scientific  point  of  view.  Soon  after  its 
appointment,  this  Committee  came  to  the  conclusion  that 
it  was  essential,  as  a  starting  point  for  further  research,  to 
draw  up  a  brief  statement  of  the  present  position  of 
knowledge.  It  appeared  that  by  this  means  research 
would  be  most  surely  guided  to  those  points  which  were 
of  practical  importance  and  regarding  which  knowledge 
was  most  urgent. 

It  also  appeared  certain  that  in  view  of  the  consider- 
ations mentioned  above,  no  impartial  statement  of  the 
case  was  likely  to  be  made,  unless  it  was  drawn  up  by 
some  public  body.  We  felt  it  therefore  incumbent 
upon  us  to  enter  upon  the  task,  however  invidious  it 
might  be. 

In  substance,  this  book  is  the  outcome  of  the  decision 
then  arrived  at.  Its  object  is  to  separate  what  is  know- 
ledge from  what  is  surmise,  conjecture,  or  popular  belief, 
and,  by  this  preliminary  clarifying  of  the  question,  to 
prepare  the  way  for  a  further  research.  It  may  be  claimed 
for  the  book  that  it  is  impartial,  not  only  in  the  sense 
that  the  authors  did  not  knowingly  or  of  set  purpose  take 
sides  with  any  existing  body  of  opinion,  but  also  in  the 
further  sense,  that  the  writers  have  frankly  admitted 
doubt,  when  the  evidence  appeared  insufficient  to  esta- 
blish a  definite  conclusion,  and  have  further  indicated 
with  absolute  sincerity  the  many  points,  some  of  them 
of  great  importance,  regarding  which  no  precise  and 
scientific  knowledge  is  available. 

It  will  perhaps  be  urged  that  this  attitude  of  mind  mars 
the  authority  with  which  the  conclusions  are  put  forward 


IX 

and  that  it  would  have  been  expedient  to  adopt  a  more 
didactic  tone. 

But  I  believe  that  complete  sincerity  is  the  only  sure 
guide  to  the  confidence  of  readers,  and  that  the  present 
condition  of  knowledge  does  not  justify  any  more  positive 
note.  No  subject  has  suffered  more  from  over-statement, 
and  from  excessive  violence  both  of  opinion  and  of 
language,  and  on  none,  therefore,  is  caution  in  drawing 
conclusions  more  necessary. 

In  the  final  section  of  the  Report  will  be  found  a  brief 
summary  of  the  principal  conclusions  to  which  the  Com- 
mittee have  been  led  provisionally. 

They  are : — 

(a)  That  the  main  action   of  alcohol  (apart  from 

the  effects  of  its  continued  excessive  use)  is 
confined  to  the  nervous  system  ; 

(b)  That  alcohol  is  narcotic  rather  than  stimulant 

in  action  ; 

(c)  That  its  nutritional  value  is  strictly  limited  ; 

(d)  That   its   habitual  use  as  an   aid  to  work  is 

physiologically  unsound  ;  and 

(e)  That  the  ordinary  use  of  alcohol  should  not 

only  be  moderate,  but  should  also  be  limited 

to  the  consumption  of  beverages  of  adequate 

dilution,  taken  at  sufficient  intervals  of  time 

to  prevent  a  persistent  deleterious  action  or 

the  tissues. 

It  is,  of  course,   common  knowledge  that  grave   and 

widespread  social  evil  follows  in  the  train  of  excessive 

consumption  of  alcoholic  beverages. 

The  physiological  findings  contained  in  the  present 
Report  have  not  been  influenced  by  preoccupation  re- 
garding the  social  issues.  But  an  increase  of  accurate 
knowledge  as  to  the  physiological  action  of  alcohol  cannot 
fail  to  be  advantageous,  both  positively  and  negatively, 
to  those  whose  duty  it  may  be  to  deal  with  those  issues. 


X 


Apart  from  affording  a  summary  of  whatever  knowledge 
is  available,  it  may  be  hoped  that  this  work  may  to  some 
extent  stimulate  the  habit  of  scientific  inquiry  into  the 
problems  in  which  alcohol  is  concerned,  and  may  make 
the  temper  in  which  they  are  discussed  less  passionate 
and  more  serene.  I  believe  that  nothing  more  beneficial 
could  be  imagined  both  as  an  aid  to  future  State-action  in 
regulating  drink  control  and  as  a  guide  to  the  individual 
in  confining  the  use  of  alcohol  within  proper  and 
legitimate  limits. 

Impartiality  in  investigation,  caution  in  drawing  con- 
clusions, moderation  in  stating  them,  and  a  certain  breadth 
in  framing  and  applying  regulations,  will  probably  prove 
the  best  aids  to  effective  and  durable  progress. 

December,  igiy.  D'ABERNON. 


CONTENTS. 


CHAPTER.  Page. 

I.  Introductory     ...          ...  ...  .  ...  i 

II.  Alcohol  as  a  food         ...  ...  .  .  ...  17 

III.  Mental  Effects  of  Alcohol  ...  ...  ...  30 

IV.  Alcohol  and  the  Performance  of  Muscular 

Acts...  ...  ...  ...  ...  ...       41 

V.  Action  of  Alcohol  on  the  Digestion  ...       56 

VI.  Action  of  Alcohol  on  the  Respiration  and 

on  the  Circulation  of  the  Blood  ...  ...       63 

VII.  Influence  of  Alcohol  on  the  Body  Tempera- 

ture   ...  ...  ...  ...  ...  ...       78 

VIII.  Poison  Action  of  Alcohol       85 

IX.  Alcohol  and  Longevity  ...  ...  ...      114 

X.  Conclusions      ...         ...         ...         ...         ...     125 

APPENDICES. 

1.     Consumption    of    alcoholic   beverages    in    the 
United  Kingdom  from  1897  to  1917 

J.     Annual  Death  Rates  from   Alcoholic  Disease 
in  England  and  Wales  from   1891  to  191 6. 


Xll 

3.  Mortality   from    Alcoholism    in    Occupational 

Groups  ... 

4.  Alcoholic  strengths  of  several  sorts  of   alco- 

holic beverages  ...  

5.  Amount   of  absolute  alcohol    in    usual    retail 

measures  of  the  ordinary   alcoholic  bever- 
ages 

Index     ... 


Alcohol:   its   Action   on   the 
Human  Organism. 


CHAPTER  I. 

Introductory. 

The  object  before  us  is  to  answer  the  question,  "What 
is  known  concerning  the  action  of  alcohol  on  the  human 
body  ?  "  An  attempt  is  to  be  made  to  review  and  appraise 
all  the  evidence  which  is  available  concerning  the  action 
of  alcohol,  regarded  simply  as  a  subject  of  physiological 
and  pathological  investigation.  It  will  appear  that  certain 
facts  concerning  this  action  can  be  accepted  as  estab- 
lished ;  that  there  are  many  others  which,  though  less 
rigidly  demonstrated,  are  supported  by  such  evidence 
that  they  may  be  accepted  as  a  basis  of  practical  opinion ; 
and  that  there  are  numerous  directions  in  which  infor- 
mation concerning  the  action  of  alcohol  is  still  so  vague 
and  unsatisfactory,  that  no  conclusion  is  legitimate, 
until  further  experiments  have  been  made  or  more 
numerous  and  accurate  data  collected. 

Definition  of  certain  terms. 

One  of  the  first  necessities  of  scientific  discussion  is  to 
define,  as  precisely  as  possible,  the  meaning  which  is  to 
be  attached  to  any  words,  concerning  the  significance  of 
which  there  can  be  any  doubt  or  possibility  of  mis- 
understanding. An  endeavour  will  be  made  to  define 
and  explain,  as  they  occur,  the  principal  scientific  terms 
which  it  may  be  necessary  to  employ  in  this  book.  The 
need  for  accurate -definition  is  especially  felt,  however, 
in  "the  case  of  familiar  words,  Which  are  in  frequent  and 


every  day  use.  The  meaning  which  popular  usage  attaches 
to  such  words  is  sometimes  vague  and  illogical ;  it  fails  to 
cover  the  whole  of  what  the  word  means  when  used  in  a 
precise  and  scientific  sense,  and  at  the  same  time  it 
suggests  ideas  which  the  word  does  not  properly  imply. 

For  example,  a  great  deal  of  controversy  has  been 
devoted  to  the  question  whether  alcohol  is  or  is 
not  a  "food,"  and  much  of  it  has  undoubtedly 
been  due  to  the  fact  that  the  disputants  were  using 
the  word  "  food "  in  different  senses.  In  popular  dis- 
cussion the  claim  that  alcohol  is  a  "  food  "  is  frequently 
opposed  by  the  production  of  evidence  that  it  is  a 
"  poison,"  the  two  statements  being  regarded  as  mutually 
exclusive.  When  we  come  to  enquire  what  precise 
meaning  can  be  attached  to  each  of  these  words,  it  will 
be  clear  that  there  is  no  reason  why  the  properties 
indicated  by  both  should  not  be  present  in  the  same 
substance ;  so  that  the  statements,  that  "  alcohol  is  a 
food,"  and  that  "alcohol  is  a  poison,"  are  not  in- 
consistent, and  may  both  be  true. 

We  shall  find,  in  fact,  that  both  are  true,  if  the  words 
'ire  used  with  the  meanings  which  will  here  be  denned. 
There  is,  further,  an  important  part  of  the  effects  of 
alcohol,  in  many  ways  the  most  important,  in  producing 
which  it  cannot  properly  be  said  to  act  either  as  a  food  or 
a  poison.  We  shall  speak  of  these  effects  as  the  "drug" 
action  of  alcohol.  We  have,  therefore,  to  consider  three 
classes  of  effects  produced  by  alcohol  on  the  human  body, 
three  aspects  of  its  action,  which  we  call  the  action  of 
alcohol  "  as  a  food,"  "  as  a  drug,"  and  "  as  a  poison." 
Our  first  duty  is  to  define  as  exactly  as  possible  what 
is  meant  here  by  "alcohol,"  "food,"  "drug,"  and 
"poison." 

What  is  meant  by  "  Alcohol" 

The  chemist  recognises  a  very  large  number  of 
substances    as    "alcohols,"    applying   the    term    to   any 


substance  having  a  certain  type  of  chemical  constitution. 
Glycerin,  for  example,  is  an  "  alcohol  "  in  this  sense,  as 
are  man)'  other  substances  to  which  the  name  would 
never  be  applied  in  ordinary  usage.  When  the  word 
alcohol  is  used  by  itself,  without  qualification,  the  sub- 
stance referred  to  is  what  the  chemist  would  call  "  ethylic 
alcohol."  This  is  the  ingredient  of  the  various  beverages 
known  as  " alcoholic  drinks"  or  "alcoholic  liquors"  to 
which  their  inebriating  properties  are  almost  entirely  due. 
The  alcohol  in  these  liquors  is  in  all  cases  produced  by 
the  fermenting  action  of  yeast  upon  sugar.  The  sugar 
may  be  that  which  naturally  occurs  in  the  juices  of  fruits, 
as  when  wines  are  obtained  by  the  fermentation  of  the 
juice  of  grapes,  or  cider  from  that  of  apples.  When 
barley  is  malted,  a  ferment  (diastase)  is  produced,  which 
in  the  process  of  brewing,  converts  the  starch  of  the  grain 
into  malt- sugar,  and  from  this  the  alcohol  of  beer  is 
produced  by  fermentation  with  yeast. 

Constituents  of  fermented  liquors. 
By  the  fermentation  of  these  natural  sugary  solutions 
liquors  are  obtained  which  contain  only  a  relatively  low 
percentage  of  alcohol.  The  fermentation,  moreover,  pro- 
duces many  other  substances  besides  ethylic  alcohol, 
though  in  much  smaller  proportions.  Some  of  these  are 
other,  alcohols  ;  one  in  particular,  called  amylic  alcohol  by 
the  chemists,  is  the  principal  constituent  of  the  product 
known  as  "fusel  oil."  Others  are  members  of  othe. 
chemical  series,  such  as  "  aldehydes "  and  "ethers." 
Some  of  these  are  present  in  the  fresh  fermented  liquor, 
whilst  others  are  formed  during  the  process  of  maturation. 
WThen  a  wine  is  matured  in  wood,  some  of  the  constituents 
present  in  the  raw  new  wine  are  slowly  abstracted. 

Distillation :  substances  found  i?i  distilled  spirit. 
Ethylic  alcohol  and  the  majority  of  these  other  sub- 
stances boil  at  a  lower  temperature  than  water  and  are  said 

16392  b 


to  be  more  "volatile."  When, therefore,  a  fermented  liquor 
is  boiled  down,  the  ethylic  alcohol  and  other  volatile 
substances  evaporate  more  readily  than  the  water  ;  and 
when  the  vapour  produced  during  the  earlier  part  of  the 
evaporation  is  condensed  in  a  still,  a  fluid  is  obtained 
containing  a  much  higher  proportion  of  ethylic  alcohol 
than  the  original  liquor,  with  different  but  always  very 
small  proportions  of  the  other  volatile  constituents.  This 
was  the  old-fashioned  method  of  obtaining  the  different 
"  distilled  spirits,"  which  resembled  one  another  in 
containing  a  high  proportion  of  ethylic  alcohol,  and 
differed  from  one  another  in  the  nature  and  proportion 
of  the  other  volatile  constituents  present,  in  addition  to 
water.  Thus,  true  brandy  owes  its  characteristic  flavour 
to  traces  of  certain  volatile  constituents  of  wine ;  4;rue 
whisky,  prepared  by  the  old-fashioned  "pot-still,"  to  those 
formed  in  the  fermentation  of  malted  grain ;  rum  to 
those  formed  in  the  fermentation  of  molasses. 

It  will  be  seen,  therefore,  that  wines,  beers,  and  dis- 
tilled spirits  prepared  as  above  described,  all  contain 
traces  of  other  active  substances  besides  alcohol.  Some 
of  them,  such  as  the  mixture  of  less  volatile  alcohols 
known  as  "  fusel  oil "  (chiefly  amylic  alcohol),  are 
much  more  poisonous  than  ethylic  alcohol  if  given  in 
equal  doses.  It  has  been  thought  that  they  may  play 
a  part  in  producing  the  bad  effects,  which  follow 
habitual  excess  in  the  use  of  alcoholic  liquors.  The 
suggestion  is  one  which  must  be  considered,  but  there  is 
very  little  evidence  to  support  it.  The  other  volatile 
substances  are  present  in  such  small  traces  that  they 
cannot  have  much  effect  on  any  property  of  the  spirit 
except  its  flavour.  Some  of  them  appear  to  be  abstracted 
slowly  when  the  spirit  is  "matured"  in  casks  ;  the  spirit 
acquires  a  more  delicate  flavour,  and  is  less  "fiery"  to 
the  taste.  Tradition  regards  spirits  so  treated  as  more 
wholesome    than    the    crude    new    product,    and     very 


probably  they  are  so.  At  the  same  time  we  must  not 
lose  sight  of  the  fact  that  tradition  and  connoisseurship, 
in  this  as  in  other  matters,  are  bound  up  with  a  good 
deal  of  convention  and  superstition.  The  modern 
scientific  apparatus  known  as  the  "  patent  still "  makes 
possible  a  much  cleaner  separation  of  the  products  of 
distillation.  By  its  use  a  practically  pure  ethylic  alcohol 
can  be  obtained,  whatever  the  nature  of  the  fermented  liquor 
treated.  Many  of  the  cheaper  brands  of  the  different 
spirits  consist  of  ethylic  alcohol  so  obtained,  diluted  with 
water  and  appropriately  flavoured  to  represent  whisky, 
gin  or  rum,  as  the  case  may  be.  There  is  no  reason  to 
suppose  that  such  preparations  are  weaker  in  inebriating 
action,  or  less  permanently  harmful  if  taken  in  habitual 
excess  than  the  products  of  the  old-fashioned  still. 
They  would  probably  be  condemned  by  the  educated 
palate  of  the  connoisseur.  Nevertheless,  there  can  be  no 
doubt  that  they  present  ethylic  alcohol  in  a  state  of 
purity,  which  no  amount  of  maturing  and  blending 
of  "pot-still"  whisky  could  achieve. 

Ethylic    alcohol   the    important    constituent   of  the 
alcoholic  liquors. 

Without  denying  the  possibility  of  a  minor  influence 
to  other  constituents,  we  can  quite  safely  assume 
that  ethylic  alcohol  is  by  far  the  most  important 
constituent  of  alcoholic  liquors,  from  the  point  of  view7  of 
the  actions  which  are  here  to  be  studied.  This  is  the 
substance  which  is  responsible  for  practically  the  whole 
of  that  action  of  alcohol  on  the  body,  which  distinguishes 
these  drinks  from  those  called  non-alcoholic,  and  which 
is  the  main  reason  for  their  use. 

We  may,  therefore,  without  any  serious  inaccuracy  use 
the  simple  word  "  alcohol  "  when  we  are  speaking  of  the 
action  of  ethylic  alcohol,  whether  it  is  taken  as  the 
chemically  pure  substance  diluted  with  water,  as  in  many 


6 

f 

of  the  experiments  which  we  shall  have  to  describe,  or 
in  the  more  complex  fluids,  such  as  beer,  wine  or  brandy, 
in  which  it  is  used  in  every-day  life.  This  is  the  sense  in 
which  the  word  "  alcohol"  will  be  used  throughout  this 
book. 

Definition  of  "  Food." 

In  defining  the  meaning  of  the  word  "food,"  it 
will  be  useless  to  try  to  frame  a  definition  which  shall 
include  everything  wiiich  everybody  admits  to  be  a  food, 
and  exclude  everything  which  is  not  so  recognised  by  all. 
For  there  are  some  who  maintain  that  alcohol  is  not  a 
food,  and  if  we  frame  our  definition  so  as  to  exclude  it, 
we  decide  in  advance  the  question  we  have  to  discuss ;  it 
becomes  a  mere  matter  of  words  and  definitions  and  has 
no  real  meaning.  If  the  question,  whether  alcohol  is  a 
food,  is  to  have  any  real  significance,  we  must  ask 
ourselves,  what  are  the  properties  implied  when  the 
word  "  food  "  is  used  in  its  ordinary  sense  ?  We  must 
define  those  properties  in  a  precise  and  scientific  manner. 
The  question  can  then  be  answered  by  a  consideration  of 
the  scientific  evidence,  as  to  whether  alcohol  has  or  has 
not  the  properties  so  defined. 

A  food,  in  the  first  place,  is  something  which  we  eat  or  drink, 
which  is  useful  for  the  normal  life  of  the  body  and  of  its 
constituent  parts,  But  such  a  definition  would  include 
substances  like  water  and  various  salts,  which  are  in- 
dispensable constituents  of  the  body,  but  are  not  usually 
regarded  as  foods.  If  the  "  man  in  the  street  "  is  asked 
why  he  does  not  regard  water  and  salts  as  foods,  he  will 
probably  reply  that  they  do  not  appease  his  hunger. 

If  this  reply  is  put  to  the  physiologist,  he  will  agree, 
and  will  proceed  to  explain  why.  He  will  explain 
that  water  and  salts  are  not  used  or  altered  by  the 
body.  The  body  is  constantly  losing  water  by  evapora- 
tion from  the  lungs  and  the  skin,  and  both  water  and 
salts  in  the  urine  and  the  sweat.     To  replace  these,  and 


preserve  the  normal  amount  of  water  and  salts  in  the 
body,  we  need  frequent  fresh  supplies ;  but  they  pass 
through  the  body  without  change. 

Consider  now  the  case  of  a  substance  such  as  sugar, 
which  everybody  recognises  as  a  food.  If  sugar  be 
eaten  in  any  ordinary  quantity  it  disappears  completely 
as  sugar,  and  no  more  of  it  can  be  recovered  than 
if  it  is  thrown  into  the  fire  and  burned.  And,  indeed, 
the  changes  undergone  by  sugar  when  it  disappears 
in  the  body  are,  in  the  end  results,  identical  with  those 
which  occur  when  it  is  burned  in  the  fire.  In  both 
cases  it  combines  with  the  oxygen  of  the  air,  with 
evolution  of  heat,  and  the  substances  resulting  are 
carbonic  acid  gas  and  water.  The  body  gets  rid  of 
these  in  the  breath  and  the  urine. 

Oxygen  and  oxidation  :  carbonic  acid. 

Oxygen  is  a  gas  which  forms  about  one-fifth  of  the 
air.  When  a  substance  burns  in  air  it  enters  into 
combination  with  the  oxygen.  Oxygen  is  likewise  the 
constituent  of  the  air,  which,  when  breathed,  supports 
life;  life  is,  indeed,  essentially  a  slow  combustion. 
Sugar  contains  the  elements  carbon,  hydrogen  and 
oxygen.  When  additional  oxygen  is  supplied,  and 
the  temperature  is  raised  sufficiently  high,  combustion 
takes  place,  the  carbon  of  the  sugar  combining  with 
oxygen  to  form  carbon  dioxide,  and  the  hydrogen  with 
oxygen  to  form  water.  Carbon  dioxide  is  the  gas  often 
called  carbonic  acid,  which  causes  the  effervescence 
of  beer,  &c,  and  "  aerated  waters "  are  artificially 
impregnated  with  it.  The  process  of  combining  with 
oxygen  is  often  spoken  of  as  "  oxidation." 

How  the  body  obtains  energy  from  food. 

There  is  another  analogy  between  the  burning  of  a 
combustible   substance,  such   as  sugar,  in  air,  and   the 


8 

oxidation  or  combustion  which  it  undergoes  in  the  bod}*. 
All  are  familiar  with  the  fact  that  the  heat  which  is 
generated  by  burning  such  a  substance  can  be  made  to 
do  work,  by  the  use  of  an  appropriate  engine  ;  in  the 
language  of  Mechanics,  part  of  the  "energy,"  which  is 
liberated  when  a  substance  is  burned,  can  be  obtained  in 
the  form  of  mechanical  work,  though  with  even  the 
most  perfect  engine  a  large  part  is  dissipated  in  the 
form  of  heat.  The  body,  just  as  truly  as  a  steam- 
engine,  obtains  the  energy  for  carding  out  the  work 
performed  by  its  different  organs  by  the  combustion  or 
oxidation  of  different  materials ;  like  the  engine,  too,  the 
body  obtains  the  liberated  energy  partly  in  the  form  of 
mechanical  work — the  work  performed  by  the  muscles  in 
moving  the  body  or  lifting  weights,  and  by  the  heart  in 
driving  the  blood  in  circulation — but  partly  as  heat, 
which  maintains  the  normal  warmth  of  the  body.  Now 
all  the  substances  which  we  recognise  as  foods  can  thus 
undergo  combustion  in  the  bod}*,  and  supply  the  heat 
and  the  power  of  doing  work  which  distinguish  the 
living  from  the  dead  body.  Water  and  salts  on  the 
other  hand,  while  essential  to  life,  only  supply  the 
conditions  necessary  for  the  use  of  other  substances  by 
the  body ;  but  they  are  not  themselves  consumed  in 
the  process,  cannot  themselves  furnish  the  energy 
which  the  body  requires,  and  therein  differ  from  the 
foods. 

Accessory  substances. 

The  same  may  be  said  of  the  so-called  "accessory 
substances,"  the  importance  of  which  has  been  made 
clear  during  recent  years.  These  are  substances  of 
which  the  nature  is  still  obscure,  which  must  be  present 
in  minute  quantities  in  the  diet  if  normal  growth  and  the 
healthy  life  of  the  body  are  to  be  maintained,  but  are  not 
themselves  a  source  of  the  energy  which  the  body  needs. 


Food  as  fuel :  the  several  classes  of  foods. 

We  have  advanced  a  step  further,  therefore,  in  our 
definition  of  a  food.  A  food  is  not  merely  something  which 
is  useful  for  the  normal  life  of  the  body  ;  it  is  a  fuel  which  the 
body  can  use  as  a  source  of  energy. 

Leaving  the  case  of  alcohol  out  of  account  for  the 
present,  we  find  that  all  the  important  constituents  of 
our  diet,  which  are  capable  of  acting  thus  as  true  foods 
or  fuels  to  the  body,  fall  into  three  classes  : — 

i.  The  carbohydrates,  including  starches,  gums  and 
sugars. 

2.  The  fats. 

3.  The  proteins,  or  albuminous  substances. 

If  we  make  a  chemical  examination  of  the  body,  we  find 
that  it  contains  substances  belonging  to  all  these  three 
classes,  though  not  necessarily  in  any  case  the  same 
individual  substances  as  the  food  contains.  By  the 
processes  which  we  call  "digestion  "  the  body  breaks 
down  all  the  food-materials,  when  necessary,  into  simpler, 
soluble  substances.  These  are  readily  absorbed,  and 
from  them  the  bod)*  builds  up  again  its  own  carbohydrates, 
fats  and  proteins. 

Special  position  of  the  proteins. 

The  proteins  are  in  a  special  position.  They  form  an 
essential  constituent  of  every  part  of  the  body  which  is 
living.  The  element  nitrogen  enters  into  their  compo- 
sition, but  not  into  that  of  fats  or  carbohydrates.  The 
body,  therefore,  cannot  form  protein  from  fats  or 
carbohydrates  ;  to  repair  the  waste  of  its  tissues  it  must 
have  protein  in  the  food.  So  that  a  certain  quantity  of 
protein  is,  in  a  peculiar  sense,  an  indispensable 
constituent  of  a  diet. 

Carbohydrates  and  fats  are  not  indispensable  in  the 
same  sense.  If  the  food  contains  more  protein  than  is 
required    for  the  repair    of   tissue,   the   body   can    form 


IO 

carbohydrate  or  fat  from  the  remainder.  But  when 
carbohydrates  and  fats  are  given  as  well,  as  in  an  ordinary 
diet,  the  body  requires  very  much  less  protein  than  if  it 
had  to  be  maintained  on  protein  alone.  Excess  of  carbo- 
hydrate can  be  stored  in  the  body  as  a  special  carbohydrate 
called  "  glycogen,,"  a  sort  of  animal  starch  ;  or  it  can  be 
converted  into  fat  and  stored  in  that  form.  Excess  of 
fat  in  the  diet  can  similarly  be  stored  as  body-fat.  The 
well-nourished  body,  therefore,  always  contains  a  good 
reserve  of  these  food-substances  or  fuels.  If  no  food  is 
taken  for  a  prolonged  period,  but  only  water,  the  body 
draws  on  its  own  reserves  of  fuel  to  maintain  the  supply 
of  energy.  It  uses  first  the  fat  and  carbohydrate,  which 
are  stored  for  this  purpose,  and  when  these  are  exhausted 
consumes  the  proteins  of  the  less  important  tissues,  such 
as  the  muscles  of  the  limbs  and  trunk,  to  maintain  the 
supply  of  energy  for  those  which  are  more  essential  for 
the  continuance  of  life. 

Ordinary  foodstuffs  used  for  tissue  repair,  or  can  be 
stored  in  the  body. 

We  have,  then,  another  property  of  all  these  three 
classes  of  food-substances.  They  can  not  only  serve  as 
fuel  for  the  body's  immediate  requirements  of  energy,  but 
can  furnish  material  for  the  repair  of  the  natural  waste 
jf  the  living  tissues,  or  for  replenishment  of  the  fuel- 
reserve  which  the  body  normally  maintains.  The  body 
not  only  can  use  them,  but  can  store  them  for  future 
need. 

Are  we  to  regard  this  also  as  an  essential  character 
of  a  "food,"  and  refuse  to  apply  that  term  to  substances 
which  can  be  used  as  immediate  fuel,  but  cannot  be 
changed  by  the  body  into  glycogen  or  fat  for  storage  ? 
The  question  is  a  very  important  one  for  our  present 
purpose,  because  on  the  answer  to  it  depends  our  con- 
clusion as  to  whether  alcohol  is  a  "  food  "  or  not.     On 


II 

the  whole  it  has  appeared  to  us  more  logical  to  admit 
that  such  immediate  fuel-substances  are  "  foods  "  also ; 
for  although  they  cannot  themselves  be  stored,  or  changed 
into  something  which  can,  by  meeting  the  immediate 
demand  of  the  body  for  fuel,  they  prevent  the  deple- 
tion of  the  reserve.  Their  addition  to  a  diet  will,  in 
the  same  way,  allow  the  body  to  use  for  replenishment  of 
its  fuel-reserve  carbohydrates  and  fats  which  it  would 
otherwise  have  to  use  immediately.  So  that  such  sub- 
stances have,  in  fact,  the  same  effect  in  a  diet  as  an 
additional  supply  of  carbohydrates  and  fats ;  they  have, 
to  a  limited  extent,  the  same  effect  as  substances  which 
are  undoubtedly  foods,  though  they  do  not  produce  it  in 
exactly  the  same  way. 

Physiological  classification  of  food-substances^ 

We  shall,  therefore,  adhere  to  our  simple  definition,  that 
a  food  is  a  fuel  which  the  body  can  use  as  a  source  of  energy. 
But  we  must  further  recognise  that  the  question  is  not 
a  simple  one  :  that  there  are  degrees  in  the  scale  of 
importance  applicable  to  food  substances,  of  which  we 
can  distinguish  three. 

Class  i.  Substances  which  can  serve  as  fuel,  to  supply 
the  energy  required  for  the  life  of  the  body,  and  which 
can  also  supply  the  material  required  for  the  repair  of  the 
living  structure.  Theoretically  the  body  could  supply  all 
its  needs  from  such  substances,  together  with  water, 
salts,  and  the  requisite  traces  of  the  "accessory  sub- 
stances" mentioned  above  (p.  8). 

To  this  first  class  belong  the  proteins  alone. 

Class  2.  Substances  which  can  serve  as  fuel  directly, 
and  can  also  be  used  to  replenish  the  fuel-reserve  of  the 
body. 

To  this  class  belong  the  carbohydrates  and  fats. 

Class  3.  Substances  which  can  serve  as  fuel,  but  are 
only  available  for  immediate  use.  They  cannot  be  used 
to  form  new  materials  for  the  body's    fuel -reserve ;  but 


12 

the)'  can  help  to  maintain  that  reserve  by  reducing  the 
need  for  drafts  upon  it,  and  by  allowing  substances  of 
Class  2  to  be  used  for  its  replenishment. 

Instead  of  asking  the  bare  question,  "  Is  alcohol  a 
food "  ?  we  shall  obtain  information  of  much  greater 
importance  and  interest  by  asking,  "  Does  alcohol  belong 
to  any  of  the  above  classes  of  food -stuffs,  and  if  so,  to 
which  "  ? 

Alcohol  a   fuel  jood  which  is  only  available  for 
immediate  use. 

We  shall  find  that  the  evidence  leads  to  the  conclusion 
that  alcohol  is  a  food  of  Class  3 ;  indeed,  it  is  the  only 
important  constituent  of  an  ordinary  dietary  belonging  to 
that  class.  We  must  make  the  position  quite  clear.  If  any- 
one chooses  to  maintain  that  the  word  "  food  "  should  be 
restricted  to  substances  included  above  in  Classes  1  and  2, 
he  is  perfectly  entitled  to  do  so.  He  would  then  be 
justified  in  stating  that  alcohol  is  not  a  food,  provided 
that  he  made  perfectly  clear  the  limited  sense  in  which 
he  was  using  the  word.  We  have  chosen,  for  reasons 
stated,  to  allow  the  word  a  more  extended  application. 
We  shall  review  the  evidence  which  shows  that  alcohol 
is  a  food  in  this  wider  sense,  and  indicates  the 
class  of  food-stuffs  to  which  it  belongs,  and  the  limits 
imposed  on  its  value  as  a  food  by  its  other  properties. 
No  one  has  the  right  to  quote  us  as  making  the  state- 
ment that  alcohol  is  a  food,  unless  he  defines,  as  we 
do,  the  exact  sense  in  which  the  word  is  used,  and  the 
limits  within  which  the  statement  is  true. 

Definition  of  metabolism. 

In  discussing  the  food-value  of  alcohol  we  shall 
frequently  have  occasion  to  use  the  term  "  Meta- 
bolism," and  it  will  be  convenient  to  define  its  meaning 
now.  The  word  metabolism  is  used  by  the  physio- 
logist to  denote  the    sum-total  of  the  chemical  changes 


that  take  place  in  the  bod}'.  The  engineer  who 
wishes  to  measure  the  efficiency  of  his  engine,  keeps 
careful  record  of  the  fuel  consumed,  the  mechanical 
work  done,  and  the  amount  of  energy  lost  as  heat. 
Similarly  the  physiologist  conducts  on  the  living  man  or 
animal  what  is  called  a  "  metabolism  experiment,"  though 
the  measurements  and  analyses  required  are  far  more 
numerous  and  elaborate  than  those  which  are  needed  for 
the  relatively  simple  mechanism  of  the  steam-engine  or 
the  petrol-motor.  A  man,  or  some  other  animal,  is  placed 
in  an  observation  chamber.  Everything  that  he  eats  or 
drinks,  and  the  air  that  he  breathes  are  measured  and 
analysed.  All  the  products  of  metabolism,  coming  out 
in  the  breath,  through  the  kidneys  or  by  the  bowels,  are 
measured  and  analysed  with  the  same  care.  The  amount 
of  work  performed  and  of  heat  lost  are  recorded,  as  well 
as  the  weight  of  the  subject  at  the  beginning  and  end  of 
the  observation.  From  all  these  elaborate  data  informa- 
tion is  obtained  as  to  the  mode  of  working  of  the  body, 
regarded  as  a  machine,  and  a  study  can  be  made  of  the 
effect  of  adding  a  particular  substance,  such  as  alcohol, 
to  the  food.  We  shall  see  that  by  such  means  evidence 
has  been  obtained  which  enables  us  to  reply  to  the  above 
questions  whether  alcohol  is  a  food,  and  to  which 
class  of  food-substances  it  belongs. 

Definition  of  drug  action. 

Apart  from  serving  as  food-materials,  in  the  manner 
already  indicated,  substances  can  influence  metabolism 
in  other  ways.  There  are  substances  which,  when 
they  are  taken  into  the  body,  can  accelerate,  retard, 
or  otherwise  modify  the  delicate  action  of  various  parts 
of  its  mechanism,  independently  of  any  contribution  to 
the  supply  of  energy.  Such  action  wTe  propose  in  this 
statement  to  term  "drug-action,"  and  to  refer  to  such 
substances  as  "  drugs." 


14 

What  is  meant  by  the  term  "drug." 
The  word  "drug"  is  used  in  different  senses  by  different 
classes  of  people.  In  popular  phraseology  it  often  means 
a  substance  of  a  deleterious  nature.  As  we  use  it  here, 
it  should  not  be  taken  to  imply  a  necessarily  harmful 
action  ;  we  use  it  simply  to  mean  a  substance  which  tem- 
porarily modifies  the  activity  of  the  bodily  organs,  includ  - 
ing,  of  course,  the  brain  and  nervous  system,  otherwise 
than  by  increasing  the  supply  of  available  energy. 
As  an  example  of  a  pure  drug-action,  in  this  sense, 
we  may  take  that  of  nitrous  oxide — the  anaesthetic  gas 
used  by  dentists.  When  this  gas  is  breathed  the 
patient  rapidly  loses  consciousness,  the  rate  of  his 
breathing  and  of  his  heart-beat,  the  activity  of  his 
muscles,  are  all  conspicuously  modified.  When  admin- 
istration of  the  gas  is  stopped,  he  rapidly  rids  himself 
through  his  breath  of  all  the  nitrous  oxide  which  he 
had  absorbed,  and  his  brain  and  organs  return  to  their 
normal  state  of  activity.  The  nitrous  oxide  has  pro- 
foundly modified  the  bodily  functions  without  being 
used  up  or  in  any  way  entering  into  the  chemical 
changes  which  we  call  metabolism.  The  effect  of 
another  familiar  anaesthetic,  ether,  differs  from  this, 
not  only  in  the  fact  that  it  is  more  prolonged,  but 
because  a  small  proportion  of  the  ether  taken  into  the 
body  is  burned ;  so  that  ether  to  a  very  small  extent 
enters  into  metabolism,  and  to  that  extent  its  action 
is  that  of  a  food,  in  the  sense  mentioned  above.  Nobody 
would  think  of  describing  ether  as  a  food,  or  of 
suggesting  it  as  a  constituent  of  a  diet ;  its  food- 
value  is  trivial,  and  its  drug-action  predominant.  When 
we  come  to  consider  alcohol,  the  case  is  different ; 
but  the  difference  is  only  one  of  degree.  Alcohol  is  a 
common  article  of  diet,  and  its  food-value  has  been  the 
subject  of  much  controversy.  But  quite  apart  from  any 
conclusion  we  reach  on  that  point,   as  the  result  of  our 


15 

examination  of  the  evidence,  we  have  to  consider  its 
drug-action.  We  shall  give  reason  for  deeming  this  the 
most  important  of  the  actions  of  alcohol,  as  taken  by 
the  majority  of  those  who  use  it. 

Importance  of  drug  action  of  alcohol. 
For,  though  alcohol  does,  in  the  sense  already  indicated, 
act  as  a  food,  it  is  seldom  taken  primarily  for  that  reason. 
It  is  to  its  drug  properties  and  to  the  agreeable  taste  of 
the  fermented  liquors  that  we  must  look  for  the  origin 
of  the  habit  of  using  the  drinks  containing  alcohol  and  of 
their  position  in  popular  esteem.  A  large  section  of  our 
statement  will  be  concerned,  therefore,  with  the  details 
of  the  action  of  alcohol  as  a  drug.  We  shall  discuss  to 
what  extent  this  action  is  useful  to  the  healthy  and  to 
the  sick,  and  to  what  extent  it  is  harmful.  It  w7ill  be 
clear  also  that  a  final  estimate  of  the  value  of  alcohol  as 
a  food  must  involve  consideration  of  the  extent  to  which 
its  use  is  limited  by  the  fact  of  its  drug-action. 

Definition  of  poison  action. 

Practically  every  drug  when  used  in  excessive  quan- 
tities, or  under  exceptional  conditions,  becomes  a 
poison ;  that  is  to  saj^,  it  so  greatly  interferes  with 
the  normal  working  of  the  bodily  functions  that  it  en- 
dangers life.  When  life  is  endangered  or  terminated 
by  a  single  large  dose  of  a  drug,  we  speak  of  the  effect 
as  "  acute  poisoning,"  and  we  shall  have  to  discuss  the 
phenomena  of  acute  poisoning  which  a  single  large  dose 
of  alcohol  will  produce.  On  the  other  hand  there  are 
many  drugs  which,  when  taken  habitually  for  long  periods, 
produce  structural  and  other  changes  of  important 
organs,  whicji  ultimately  lead  to  permanent  ill-health, 
and  may  be  the  cause  of  death.  We  call  such  a  condition 
"  chronic  poisoning."  It  should  be  noted  that  the 
chronic  effects  may  have  no  relation  whatever  to  the 
symptoms  of  what  we  have  called  the  "  drug-action,"  or 


i6 

of  acute  poisoning  by  the  same  substances.  Each  in- 
dividual dose,  from  the  succession  of  which  the  chronic 
poisoning  results,  may  be  so  small  as  to  produce  but 
slight  symptoms  of  drug-action,  and  those  of  an  agreeable 
and  apparently  favourable  nature. 

Short  of  dangerous  illness  or  death,  there  are  minor 
defects  and  infirmities,  affecting  perhaps  only  some  organ 
or  system  which  is  not  essential  to  the  life  of  the 
individual,  which  may  result  from  chronic  poisoning. 
The  body  may,  through  the  prolonged  action  of  a 
poison,  acquire  a  weakness,  a  lessened  resistance  to 
disease  or  injury,  which  is  imperceptible  in  health,  and 
only  becomes  manifest  when  the  subject  is  exposed  to 
infection  or  violence.  We  shall  have  to  discuss  the 
possibility  of  the  body  being  affected  in  any  of  these  ways 
by  the  habitual  use  of  alcohol. 


17 

CHAPTER  II. 
Alcohol  as  a  Food. 

Absorption  of  alcohol. 

In  considering  the  value  of  any  substance  as  a  food,  it 
is  necessary  to  know  in  the  first  place,  to  what  extent, 
and  with  what  rapidity  it  is  absorbed  from  the  stomach 
and  intestine ;  for  it  is  not  until  the  substance  has 
passed  into  the  blood,  by  the  circulation  of  which  it  is 
distributed  to  the  tissues  which  can  make  use  of  it, 
that  the  true  action  as  a  food  begins. 

However  easily  combustible  a  substance  may  be  out- 
side the  body,  unless  it  is  soluble  in  the  blood,  or  can 
be  changed  by  digestion  into  something  which  is  solu- 
able,  it  cannot  act  as  a  food.  A  substance  like  paraffin, 
for  example,  although  it  burns  readily  in  air,  is 
completely  insoluble  in  the  fluids  of  the  body,  and  when 
it  is  taken  into  the  stomach,  it  passes  unchanged  through 
the  intestine  and  does  not  act  as  a  food  at  all.  Alcohol, 
on  the  other  hand,  is  completely  soluble  in  water,  wTith 
which  it  mixes  perfectly  in  all  proportions,  so  that  it 
does  not  need  to  be  rendered  soluble  by  digestion. 
We  should  expect  it,  therefore,  to  be  absorbed  quickly 
and  completely  ;  experiment  has  shewn  that  this  is  the 
case. 

Analyses  of  the  contents  of  the  stomach  and  intestines, 
made  at  different  intervals  after  a  dose  of  alcohol  has  been 
swallowed,  shew  that  about  one-fifth  of  it  is  absorbed 
from  the  stomach.  In  the  uppermost  section  of  the 
small  intestine  one  -  tenth  is  absorbed,  but  the  main 
absorption,  accounting  for  one  half  of  the  quantity 
taken,  occurs  in  the  middle  part  of  the  small  intes- 
tine, the  remaining  one-fifth  being  absorbed  in  the  third 
and  last  section.     By  the    time  the  alimentary  contents 


i8 

reach  the  large  intestine,  all  the  alcohol  has  been  taken 
up  from  thern  into  the  blood. 

The  absorption  of  alcohol  is,  therefore,  complete,  and, 
in  comparison  with  that  of  food-stuffs  needing  pre- 
liminary digestion,  such  as  meat,  it  is  conspicuously 
rapid.  The  actual  speed  of  absorption  seems  to  vary 
with  a  number  of  conditions,  such  as  the  form  in  which 
the  alcohol  is  taken,  the  extent  to  which  it  is  diluted,  and 
the  time  in  relation  to  meals ;  but  the  interaction  of  the 
different  factors  is  evidently  very  complicated,  and  there 
is  no  evidence  so  clear  as  to  warrant  a  definite  statement 
concerning  the  effect  of  any  of  these  factors. 

Excretion. 

The  second  point  on  which  information  is  required,  in 
estimating  the  food-value  of  a  substance,  is  the  extent 
to  which  the  body  can  use  it  after  it  has  passed  into  the 
circulation.  We  can  obtain  an  indication  of  this  by 
determining  to  what  extent  it  leaves  the  body  again  un- 
changed. The  processes  by  which  the  body  discharges 
materials  which  it  does  not  use  further  are  collectively 
termed  "excretion"  by  physiologists. 

Mention  has  been  made  of  the  case  of  sugar,  any 
ordinary  quantity  of  which  is  burned  completely  in  the 
body,  so  that,  except  in  some  diseased  conditions  such  as 
diabetes,  no  sugar  can  be  found  amongst  the  waste 
materials  in  the  urine.  Sugar,  therefore,  is  used  by  the 
body  to  its  full  value.  We  may  contrast  with  this  the 
case  of  saccharin,  a  complex  coal-tar  derivative,  which  is 
sometimes  used  in  place  of  sugar,  on  account  of  its 
intensely  sweet  taste.  Saccharin,  in  ordinary  quantities, 
is  absorbed  completely  from  the  stomach  and  bowel,  but 
the  whole  amount  taken  can  be  recovered  unchanged  in 
the  urine ;  so  that  saccharin  is  not  a  food  at  all,  and  its 
whole  value  is  in  its  sweetness. 

Alcohol,  being  a   substance   which  readily    evaporates, 


can  leave  the  body  to  some  extent  in  the  breath,1  as  well 
as  in  the  urine,  and  both  must  be  analysed  in  order  to 
determine  the  proportion  of  a  dose  of  alcohol  which  is 
excreted.2 

In  all  the  experiments  of  this  kind  which  have  been 
made  this  proportion  has  been  found  to  be  a  small  one, 
though  it  is  not  constant.  It  is  increased  by  any 
influence  which  quickens  the  absorption  of  alcohol  from 
the  stomach  and  intestine,  or  the  formation  of  urine  by 
the  kidneys,  or  which  augments  the  vigour  of  the 
respiration.  But  under  the  conditions  most  favourable  to 
this  loss  of  unchanged  alcohol  in  the  breath  and  urine, 
it  never  amounts  to  more  than  one-tenth  of  the  quantity 
swallowed.  Usually  much  less  is  lost  in  this  manner — on 
an  average  about  one-fiftieth  ;  and  in  people  who,  by 
taking  alcohol  habitually,  have  acquired  the  power  of 
using  it  up  more  rapidly  than  those  unaccustomed  to  it, 
as  little  as  one-hundredth  part  of  a  moderate  dose  of 
alcohol  may  escape  in  the  breath  and  the  urine. 

The  quantity  of  alcohol  excreted  as  such  by  the  body 
is    always   small,  therefore,  and   may   be  trivial.     What 

1  It  should  be  noted  that  the  odour  of  the  breath,  associated 
with  the  taking  of  alcoholic  liquors,  is  mostly  due  to  other 
substances  than  alcohol,  which  has  but  a  faint  odour. 

2  There  is  no  evidence  that  alcohol  is  ever  eliminated  in  appre- 
ciable amount  in  the  sweat.  Traces  of  the  drug  have  been  found 
in  the  milk,  in  experiments  in  which  large  doses  of  alcohol  were 
given  to  cows  and  goats  ;  and  some  observers  have  also  detected 
its  presence  in  the  milk  of  women  of  alcoholic  habits.  It  is 
probable,  however,  that  this  occurs  only  when  large  quantities  of 
alcohol  are  taken,  and  that  even  then,  the  amount  excreted  is  too 
small  to  have  any  influence  on  the  health  of  the  infant.  In  this 
connection  it  may  further  be  mentioned  that  the  available  evidence 
gives  no  support  to  the  popular  belief  that  alcoholic  beverages, 
and  particularly  malted  liquors,  promote  the  production  of  milk, 
and  are  therefore  to  be  recommended  to  nursing  mothers. 
Whether  in  the  form  of  spirits  or  of  beer,  alcohol  does  not  seem 
to  have  any  effect  whatever  on  either  the  quantity  or  the  quality 
of  this  secretion.  (R.  Rosemann,  in  Pfluger's  Archiv,  Vol.  78, 
1889). 

16392  e 


20 


becomes  of  the  remainder?  This  question  must  be 
answered  before  any  conclusion  can  be  drawn  as  to  the 
food-value  of  alcohol. 

How  the  body  uses  alcohol. 
Though  little  of  the  alcohol  escapes  as  such  in  the  urine 
and  breath,  the  residue  does  not  remain  long  in  the  body.  In 
from  fifteen  to  twenty-four  hours  after  a  dose  of  alcohol  has 
been  taken,  the  whole  of  it  has  disappeared  completely. 
The  destruction  of  the  alcohol,  indeed,  begins  as  soon  as  it 
reaches  the  blood.  Samples  of  blood  can  be  taken  from  a 
man  or  other  animal  at  intervals  after  a  dose  has  been 
swallowed,  and  the  proportion  of  alcohol  in  each  sample  can 
be  determined  by  analysis.  In  this  way  it  has  been  found 
that  for  the  first  few  hours  the  alcohol  is  passing  into  the 
blood  more  rapidly  than  it  is  destroyed,  so  that  the 
concentration  in  successive  samples  rises.  After  an 
interval,  varying  with  the  dose  among  other  conditions, 
the  concentration  reaches  a  maximum,  and  usually 
remains  at  about  that  level  for  some  time.  This 
maintenance  of  a  level  concentration  does  not  mean  that 
the  absorption  has  been  completed,  but  that  it  has  been 
overtaken  by  the  destruction,  and  that,  for  the  time  being, 
the  two  processes  practically  balance  one  another.  Then 
the  rate  at  which  alcohol  disappears  becomes  greater 
than  that  at  which  it  is  entering  the  circulation,  so  that 
the  concentration  in  the  blood  declines,  until  after  about 
24  hours  no  more  alcohol  can  be  discovered  anywhere  in 

the  body. 

The  maximum  concentration  which  alcohol  reaches 
in  the  blood  bears  a  regular  relation  to  the  original 
dose :  thus,  it  was  shewn  by  Grehant1  that  when  an 
animal  had  taken  a  dose  of  alcohol  equivalent  to 
one  -  thousandth  of  its  body  weight  (i.e.  a  dose  of 
1    cubic    centimetre     per    kilogram),    the    highest    pro- 

1  Grehant.— Comptes  rendus  de  la  Soci£te  de  Biologie,  1881, 
1896,  and  1899. 


21 


portion  subsequently  found  in  the  blood  was  about 
i  per  thousand ;  with  a  dose  of  2  ce.  per  kilogram 
the  blood  contained  about  2  per  thousand,  and  so  on. 
This  would,  at  first  sight,  appear  to  mean  an  equal  dis- 
tribution of  the  alcohol  throughout  the  body.  It  does 
not  mean  this,  however ;  for  when  the  maximum  concen- 
tration is  attained  in  the  blood,  some  part  of  the  dose  has 
already  been  destroyed,  while  some  of  it  is  still  unabsorbed. 
It  so  happens  that  the  balance  of  absorption  over  destruc- 
tion brings  the  maximum  concentration  in  the  blood  to 
the  value  which  wTould  be  obtained  by  an  immediate  dis- 
tribution of  the  whole  dose  through  the  whole  of  the 
tissues  of  the  body;  but  the  correspondence  is  accidental. 

Products  of  combustion  of  alcohol. 

What  has  become  of  the  alcohol  ?  Only  a  little  of  it  can 
be  found  passing  out  of  the  body ;  and  yet,  after  24  hours 
none  can  be  found  in  the  bod3*.  There  being  no  evidence 
of  its  change  into  some  other  substance  which  the  body 
can  retain,  the  supposition  is  natural  that  it  is  completely 
"oxidised"  or  burnt,  producing,  as  when  burnt  in  air, 
carbon  dioxide  and  water,  which  pass  out  in  the  breath 
and  urine.  The  method  by  which  this  supposition  can 
be  put  to  the  test  of  direct  experiment,  must  now  be 
described. 

All  food-substances  contain  carbon  and  hydrogen,  and 
therefore  yield  carbon  dioxide  and  water  when  they  are 
oxidised  in  the  bod}'.  The  carbon  dioxide  leaves  the 
body  very  quickly  in  the  breath,  the  rate  and  depth  of 
breathing  being  uormalh*  so  adjusted  as  to  keep  the 
amount  of  it  in-  the  blood  nearly  constant  (see  p.  68). 

The  quantity  of  carbon  dioxide  and  water  formed, 
and,  therefore,  the  amount  of  carbon  dioxide  passing  out 
in  the  breath,  varies  from  minute  to  minute,  with  changes 
in  the  activity  of  the  muscles  and  other  organs.  A  mere 
measurement  of  the  rate  at  which  carbon  dioxide  is 
turned  out   in  the  breath,  after  alcohol  has  been  taken, 


'22 

will  not  give  much  information  as  to  the  extent  to  which 
alcohol  is  oxidised.  For,  even  if  variations  due  to  the 
activity  of  the  muscles  or  other  organs  were  excluded, 
an  increase  in  the  production  of  carbon  dioxide,  following 
a  dose  of  alcohol,  would  not  necessarily  mean  that  the 
alcohol  was  being  burnt.  It  might  mean  merely  that  the 
taking  of  alcohol  caused  the  body  to  burn  more  fat, 
carbohydrate  or  protein.  Another  measurement  is  needed 
as  well,  namely,  the  rate  at  which  oxygen  is  used  up  in 
the  air  which  is  breathed. 

The  Respiratory  Quotient. 

When  a  carbohydrate,  such  as  sugar,  is  burnt  in  the  air, 
the  volume  of  oxygen  which  disappears  from  the  air  is 
exactly  the  same  as  the  volume  of  carbon  dioxide  which 
is  formed.  This  is  not  true  of  any  other  food-substances ; 
when  fats  or  proteins  are  burnt,  the  volume  of  oxygen 
used  is  always  larger  than  that  of  the  carbon  dioxide 
which  is  produced.  And  there  is  a  difference  of  the 
same  kind,  but  greater,  when  alcohol  is  burnt. 

Readers  with  a  slight  knowledge  of  chemistry  will 
readily  understand  the  reason  of  this  difference.  Carbo- 
hydrates, fats  and  alcohol  are  all  composed  of  carbon, 
hydrogen  and  oxygen.  The  amount  of  oxygen  present 
in  a  carbohydrate  is  just  sufficient  to  combine  with  all 
the  hydrogen  to  form  water,  so  that  when  a  carbohydrate 
is  burnt  only  sufficient  extra  oxygen  is  required  to  com- 
bine with  the  carbon  ;  and  when  oxygen  combines  writh 
carbon,  the  volume  of  carbon  dioxide  formed  is  equal  to 
that  of  the  oxygen  used.  Substances  like  fat  contain  a 
smaller  proportion  of  oxygen,  insufficient  to  combine 
with  all  their  hydrogen,  so  that,  when  they  are  burnt, 
they  use  up  a  volume  of  oxygen  which  is  larger  than 
that  of  the  carbon  dioxide  which  is  formed.  The  differ- 
ence is  still  larger  in  the  case  of  alcohol,  which  contains 
a  smaller  proportion  of  oxygen  than  the  fats. 


23 

The  same  difference  between  carbohydrates  and  other 
food-substances  appears  when  they  are  used  in  the  body. 
By  analysing  the  air  which  is  breathed  in  and  that 
which  is  breathed  out  by  a  man,  or  other  animal,  over  a 
long  period,  the  amount  of  oxygen  used  and  the  amount 
of  carbon  dioxide  formed  in  the  body  are  determined. 
These  are  compared  by  making  a  fraction  : — 
Volume  of  carbon  dioxide  formed 

Volume  of  oxygen  used, 
and  this  is  called  the  "  respiratory  quotient"  When  the 
two  volumes  are  nearly  equal,  so  that  the  value  of  the 
fraction  approaches  unity,  we  know  that  the  body  is 
using  chiefly  carbohydrates.  When  the  volume  of  the 
oxygen  used  is  greater  in  proportion,  so  that  the  respira- 
tory quotient  becomes  smaller,  we  know  that  some  food- 
substance  other  than  carbohydrate  is  being  burnt.  The 
respiratory  quotient  resulting  from  the  oxidation  of 
alcohol  would  be  lower  than  that  corresponding  to  any 
of  the  ordinary  food-stuffs  ;  so  that,  if  alcohol  is  oxidised 
in  the  body,  the  addition  of  alcohol  to  the  diet  should  be 
followed  by  a  fall  of  the  respiratory  quotient. 

Degree  to  which  alcohol  is  oxidised  in  bod  v. 
A  series  of  elaborate  and  careful  experiments  of  this 
kind  was  carried  out  by  Atwater  and  Benedict1  in  America, 
and  their  observations  have  been  confirmed  by  other 
workers.  The  results  give  definite  proof  that  alcohol  is 
oxidised  in  the  body  as  completely  as  the  carbohydrates, 
and  rather  more  completely  than  the  fats  and  proteins. 

Alcohol  a  fuel  food. 

It  has  been  suggested  that  the  energy  liberated  by  this 

oxidation  of  alcohol  cannot  be  used  by  the  body,  but  is 

lost  in  the  form  of  superfluous  heat.     This  possibility  has 

been   examined  and   disproved.     Atwater  and    Benedict 

1  Physiological  Aspects  of  the  Liquor  Problem,  New  York,  1903. 


24 

were  able  to  shew  that  the  bod)"  can  derive  up  to  one- 
fifth  of  the  total  energy  it  requires  from  the  metabolism 
of  alcohol.  There  can  be  no  doubt,  therefore,  that  alcohol 
is  a  "  food,"  in  the  sense  of  a  fuel  that  the  body  can  use. 

We  have  seen  that  alcohol  is  not  stored  by  the  body. 
There  remains  to  be  considered  the  extent  to  which  it 
can  replace  each  of  the  ordinary  food-stuffs. 

How  far  alcohol  can  replace  ordinary  food-stuffs  : 
(i)  Carbohydrates. 
Experiments  of  the  kind  described  above  have  shewn 
that,  up  to  a  certain  point,  carbohydrate  can  be  replaced 
by  alcohol.  A  man  was  kept  on  a  standard  measured  diet, 
rich  in  carbohydrates,  and  his  respiratory  quotient  was 
carefully  determined.  A  ration  of  alcohol  was  then 
added  to  the  diet.  The  respiratory  quotient  fell  promptly, 
and  to  such  an  extent  as  to  shew  that,  while  the  alcohol 
was  being  oxidised,  carbohydrate  was  being  saved  from 
oxidation  and  added  to  the  fuel  reserve  of  the  man's  body. 

(2)  Fats. 
All  those  who  have  made  experiments  on  the  point,  agree 
in  finding  that  alcohol  can  take  the  place  of  part  of  the 
fats  in  a  diet.  If  a  fixed  diet,  sufficient  for  maintenance, 
is  given,  the  addition  of  alcohol  to  it  protects  some  fat 
from  oxidation,  and  allows  more  fat  to  be  added  to  the 
body's  reserve  supply. 

(3)  Proteins. 
The  case  of  the  proteins  is  peculiar.  They  contain 
nitrogen,  and  a  small  proportion  of  sulphur,  in  addition 
to  carbon,  hydrogen,  and  oxygen,  and,  as  stated  above,  the 
animal  body  can  obtain  the  materials  for  repairing  the 
wear  and  tear  of  its  proteins,  only  from  proteins  in 
the  food.  Neither  carbohydrates,  nor  fats,  nor  alcohol  can 
replace  in  the  food  the  protein  needed  for  this  purpose. 
But  an  ordinary  diet  contains  protein  much  in  excess  of 
this  minimum  needed  for  repair,  and  this  excess  is  oxidised 


25 

to  furnish  energy.  The  amount  of  protein  which  is  thus 
being  burnt  can  be  estimated  by  determining  the  sub- 
stances containing  nitrogen  which  leave  the  body  in  the 
urine. 

When  protein  alone  is  given  as  a  food,  the  body  destroys 
such  a  large  proportion  of  it,  that  a  large  amount 
of  it  must  be  given ;  otherwise,  the  body  loses  more 
nitrogen  in  the  urine  than  it  receives  in  the  food — an 
indication  that  the  natural  wastage  of  the  body's  own 
protein  is  not  being  made  good.  But  if  fat  or  carbo- 
hydrate is  given  in  addition,  the  proportion  of  the  food 
protein  which  is  thus  burnt  is  much  reduced,  so  that  a 
larger  proportion  is  available  for  repairing  the  waste  of 
the  tissues,  and  a  smaller  ration  of  protein  suffices. 

The  question  which  we  have  now  to  consider  is  whether 
alcohol  can  also  act  in  this  way.  And  it  will  be  clear 
that  we  are  not  discussing  whether  alcohol  can  take 
the  place  of  protein,  for  nothing  can  truly  do  so  ;  the 
question  is  whether  alcohol  can  act  like  carbohydrates 
and  fats  in  economising  protein,  by  reducing  to  a 
minimum  the  amount  which  the  body  requires.  The 
general  result  of  experiments  made  to  determine  this 
point,  shews  that  it  can. 

The  method  of  experiment  is  to  put  the  subject  on  a 
mixed  ration,  containing  known  amounts  of  protein, 
carbohydrate  and  fat.  A  daily  determination  is  made  of 
the  nitrogen  lost  in  the  urine  on  this  standard  diet.  The 
diet  is  so  adjusted  to  the  needs  of  the  subject  that  a 
reduction  of  the  carbohydrate  or  fat  will  lead  to  the 
burning  of  more  protein,  which  will  be  indicated  by  the 
loss  of  more  nitrogen  in  the  urine.  But  instead  of  merely 
reducing  carbohydrate,  the  effect  can  be  tried  of  sub- 
stituting for  it  a  chemically  equivalent  amount  of  alcohol. 
For  example,  the  original  diet  may  contain  a  high  pro- 
portion of  sugar ;  a  large  part  of  this  can  be  dropped, 
and  a  corresponding  ration  of  whisky  given  instead.     If 


26 

this  change  does  not  cause  the  appearance  of  more 
nitrogen  in  the  urine,  we  have  evidence  that  the  alcohol 
is  acting  like  the  sugar  as  an  economiser  of  protein. 

Most  observers  who  have  used  this  method  are  agreed 
that  alcohol  can  act  like  a  carbohydrate  in  this 
respect  also,  the  amount  of  protein  burnt  in  the  body 
remaining  just  the  same  after  the  change  from  carbo- 
hydrate to  alcohol.  Others  have  found  evidence  of  an 
increased  destruction  of  protein  when  the  change  is  made, 
and  have,  therefore,  maintained  that  alcohol  has  not  the 
same  power  as  the  carbohydrates  have  of  saving  protein. 
There  is  good  reason  to  believe,  however,  that  this  result 
was  due  to  the  fact  that  the  subjects  of  these  experiments 
were  not  accustomed  to  taking  alcohol,  and  it  seems  to 
be  clearly  established  that,  in  those  who  are  used  to  it, 
alcohol  in  moderate  quantity  is  as  efficient  as  carbo- 
hydrates or  fats  in  reducing  the  amount  of  protein 
required  by  the  body  to  maintain  itself,  by  saving  the 
proteins  from  being  used  merely  as  a  source  of  energy. 

Has  alcohol  a  special  actum  on  nutrition  ? 

Reference  has  already  been  made  to  the  presence  in  an 
efficient  diet  of  traces  of  so-called  "accessory  substances," 
which  are  not  themselves  foods,  but  have  a  profound 
influence  on  the  power  of  the  body  to  nourish  itself  on 
the  true  food-stuffs.  It  is  necessary  to  discuss  whether 
alcohol  has,  apart  from  its  food-value  in  the  sense 
already  defined,  any  such  specific  stimulant  action  on 
nutrition.  Medical  opinion  formerly  attributed  to  alcohol 
an  effect  of  this  kind ;  certain  wines  and  beers  especially 
were  credited  with  special  value  in  the  "  building  up  of 
the  constitution,"  and  were  widely  prescribed  in  cases  of 
malnutrition,  such  as  that  due  to  tubercular  infection. 
This  view  is  no  longer  widely  held  by  medical  men,  but 
appears  still  to  be  current  as  an  article  of  popular  belief. 


27 

There  are  probably  many  who  regard  abstinence  from 
alcohol  as  incompatible  with  the  development  and  pre- 
servation of  a  robust  and  vigorous  bodily  habit.  Accurate 
observations  lend  no  support  to  such  a  belief.  The  food- 
value  of  alcohol,  within  limits,  is  no  less  than  that  of  a 
corresponding  quantity  of  sugar  or  lard ;  but,  on  the 
other  hand,  there  is  no  evidence  for  its  ever  being 
greater.  If  sufficient  food  is  being  taken  in  other  forms, 
the  addition  of  alcohol  to  the  diet  may  lead  to  the 
accumulation  of  fat,  but  it  will  not  improve  the  nutrition. 
When  wine  or  beer  aids  recovery  after  a  wasting 
disease,  it  does  so  because  the  food  taken  in  ordinary 
forms  is  not  adequate.  In  such  circumstances,  the 
alcohol  is  of  some  use  in  increasing  the  food-value  of 
the  diet;  but  its  main  effect  is  probably  in  making 
the  patient  more  comfortable  and  contented,  and  thereby 
improving  his  appetite  for  ordinary  foods.  This  is  not  a 
special  action  on  nutrition,  but  a  drug  action,  which  will 
be  considered  in  a  subsequent  chapter. 

Summary. 

It  will  be  useful  now  to  summarise  the  conclusions 
which  seem  to  be  justified  by  the  evidence  discussed  in 
this  chapter,  and  to  consider  their  practical  bearings. 

i.  Alcohol  is  completely  and  rapidly  absorbed  from  the 
stomach  and  intestine,  and  distributed  by  the  circulating 
blood  to  the  different  organs  of  the  body.  The  rate  of  its 
absorption  is  modified  by  conditions  which  still  need 
further  investigation. 

2.  A  variable  but  always  small  proportion  of  alcohol 
escapes  unchanged  in  the  breath  and  urine.  The  rest 
disappears  completely  in  about  24  hours  after  it  has  been 
swallowed. 

3.  The  concentration  of  alcohol  in  the  blood  rises  for 
a  few  hours  after  it  has  been  swallowed,  remains  nearly 
constant    for   a    few    hours   longer,   and    then    steadily 


28 

declines.  The  duration  of  these  phases  is  modified  by 
conditions  affecting  either  the  rate  of  absorption  or  the 
rate  of  disappearance  ;  but  the  evidence  as  to  the  nature 
of  these  conditions  is  still  very  imperfect.  There  is,  how- 
ever, good  evidence  of  an  increased  rate  of  disappearance 
in  subjects  who  have  become  habituated  to  taking  alcohol 
{vide  chapter  on  "  Poison  Action,"  p.  85). 

4.  The  disappearance  of  alcohol  from  the  body,  apart 
from  the  small  proportion  escaping  unchanged,  is  due  to 
its  being  oxidised  (burnt).  None  of  the  alcohol  is  known 
to  be  converted  into  any  substance  which  the  body  can 
retain. 

5.  The  energy  liberated  by  the  combustion  of  a  mode- 
rate amount  of  alcohol  can  be  used  by  the  body  to  its  full 
value. 

6.  Alcohol  can,  within  limits,  replace  an  equivalent 
amount  of  carbohydrate  or  fat  in  a  diet,  and  has  a  similar 
effect  in  economising  proteins. 

7.  The  whole  food-value  of  alcohol  is  due  to  its  use  by 
the  body  as  a  fuel. 

Food-value  of  alcohol  qualified  by  its  drug  action. 

The  conclusions  thus  summarised  are  concerned  with 
the  purely  scientific  question,  whether  alcohol  acts  as 
a  food  in  the  sense  here  defined.  The  question  whether 
a  substance  is  a  desirable  constituent  of  a  diet,  whether 
its  use  is  advisable,  is  a  much  wider  one  than  this, 
and  involves  many  considerations  other  than  that  of  the 
body's  ability  to  use  it  as  a  fuel.  There  are  other 
substances  which  the  body  oxidises  as  completely  as  it 
does  alcohol,  such  as  citric  or  acetic  acid  (the  acids 
contained  in  lemon  juice  and  vinegar  respectively). 
Nobody  would  suggest  that  either  of  these  substances 
could  be  taken  in  such  quantities  as  to  make  a  material 
contribution  to  the  fuel  required  by  the  body.  In 
practice  they  are  not  so  taken,  being  used  only  in  small 


2y 

quantities,  for  their  acid  taste,  and  not  for  their  food- 
value.  Their  other  properties  make  it  impossible  to 
take  them  in  large  quantities.  Theoretically  they  are 
foods  ;  practically  their  use  as  such  is  negligible. 

Similarly,  in  discussing  the  evidence  for  the  action  of 
alcohol  as  a  food,  it  has  repeatedly  been  necessary  to  use 
qualifying  expressions  such  as  "within  limits,"  "in  mode- 
rate quantities,"  etc.  These  limits  are,  of  course,  imposed 
by  the  other  effects  of  alcohol,  which  will  form  the  subject 
of  the  ensuing  chapters.  The  question,  as  to  how  far 
the  theoretical  value  of  alcohol  as  a  food  is  in  practice 
restricted  and  counterbalanced  by  these  other  properties, 
must  be  left  till  they  have  been  considered.  It  is 
desirable  here,  however,  to  emphasise  the  fact  that,  for 
the  normal  man,  alcohol  has  no  advantage  over  an 
ordinary  food-substance  like  sugar,  from  the  point  of 
view  of  its  food-value  alone.  The  question  of  its  food- 
value  cannot,  therefore,  be  allowed  much  weight  in  the 
practical  decision  of  the  individual  as  to  whether  he 
should  or  should  not  take  alcohol.  This  question  must 
be  decided  rather  by  a  balancing  of  the  advantageous 
features  of  what  is  here  termed  its  "drug-action"  against 
those  which  are  undesirable,  and  against  the  risk  of  the 
wholly  bad  effects  included  under  its  action  as  a  "poison." 


3° 


CHAPTER  III. 

Mental  Effects  of  Alcohol. 

Effect  of  environment  on  symptoms  of  drunkenness. 

The  aspect  of  drunkenness  which  has  most  impressed 
the  popular  mind  is  that  of  boisterous,  disordered 
and  even  violent  activity  of  mind  and  body  which 
not  infrequently  appears  as  one  phase  of  the  process 
of  intoxication.  But  this  phase  commonly  appears 
under  social  conditions  which  stimulate  the  emotions ; 
alcohol  undoubtedly  diminishes  the  control  of  the 
intellect  and  the  will  over  the  emotions,  and  it  appears 
not  improbable  that  this  passing  phase  of  excitement 
may  be  sufficiently  accounted  for  by  exciting  influences 
of  the  environment,  the  jovial  company,  the  bright  lights, 
the  unrestrained  talk  and  song,  the  general  sense  of 
festivity,  which  are  the  common  setting  of  the  feast. 
The  conclusion  indicated  by  laboratory  tests  of  mental 
and  bodily  capacity  is  borne  out  by  simple  observation 
of  one's  self  or  of  other  subjects,  if  one  takes  successive 
doses  of  alcohol  in  the  absence  of  all  such  exciting 
influences.  The  first  effect  generally  noticed  is  a  slight 
giddiness  or  "  light-headedness ;  "  this  is  followed  by  au 
increasing  heaviness  and  disinclination  for  all  effort, 
soon  passing  into  sleepiness ;  and  this  in  turn,  if  not 
counteracted  by  any  excitement  coming  from  within  or 
without,  gives  place  to  a  heavy  sleep  which  continues  for 
many  hours. 

Feeling  of  well-being  induced  by  alcohol. 

We  may  notice  at  once  that  even  under  these  condi- 
tions alcohol  produces  to  some  degree  that  effect  which, 
perhaps  more  than  any  other,  is  the  secret  of  its 
charm,  its  well-nigh  universal  attraction  for  the  human 


3i 

race,  namely,  a  sense  of  careless  well-being  or  bodily 
and  mental  comfort.  In  so  far  as  this  sense  of  well- 
being  is  of  bodily  origin,  it  is  no  doubt  largely  due  to  a 
flushing  of  the  skin  with  blood  that  abolishes  all  sense 
of  chill ;  but  it  is  due  also  in  part  to  a  blunting  of  the 
sensibility  to  the  small  aches  and  pains  and  a  thousand 
hardly  distinguishable  sense-impressions  which,  except 
in  those  in  perfect  health,  contribute  to  tip  the  balance 
of  bodily  feeling-tone  to  the  negative  or  unpleasant  side. 
In  so  far  as  this  effect  is  primarily  mental,  it  results 
from  the  blunting  of  those  higher  mental  faculties  which 
lead  us  to  "  look  before  and.  after  and  pine  for  what  is 
not"  and  harass  us  with  care  for  the  future  and  a  too 
sensitive  self-consciousness  for  the  present. 

Appearance  of  excitement  not  due  to  any  stimulant  action  of. 

alcohol. 

If  on  the  other  hand  the  drinker  is  subjected  to  the 
stimulation  that  comes  from  social  intercourse  he  usually 
passes  through  a  phase  which  may  be  justly  called  one 
of  excitement,  the  degree  of  excitement  depending  upon 
the  temperament  of  the  drinker  and  the  nature  and 
degree  of  the  external  stimuli.  But  careful  observa- 
tion of  and  reflexion  upon  the  phenomena  of  this  stage 
shew  clearly  that  they  do  not  require  for  their  explana- 
tion the  assumption  that  alcohol  stimulates  the  nervous 
system,  whether  directly  or  through  the  medium  of  other 
bodily  organs. 

The  drinker's  conversation  and  actions  become  less 
restrained ;  all  his  emotional  responses  are  freer  and 
fuller  than  in  his  normal  state.  He  laughs  and  smiles 
more  readily,  he  grows  more  easily  angry  or  tender, 
elated  or  depressed,  scornful  or  compassionate,  according 
to  the  appeal  of  the  moment.  Perhaps  the  various 
emotional  states  into  which  fear  enters  as  an  element, 
and  which  we  denote  by  such  names  as  anxiety,  worry, 


32 


care,  despondency,  are  exceptions  to  this  rule.  This 
group  of  exceptions  is  readily  explicable  on  the  prin- 
ciple that  we  apply,  namely,  that  alcohol  successively 
weakens  and  suspends  the  hierarchy  of  functions  of 
the  brain,  and  therefore  of  the  mind,  in  the  order  from 
above  downwards  ;  that  is  to  say  in  the  inverse  order 
of  their  development  in  the  individual  and  in  the  race. 
For  the  emotional  dispositions  or  capacities  are  a  very 
ancient  racial  endowment  and  have  their  physiological 
seats  in  the  basal  ganglia,  the  lowest  levels  of  the  great 
brain,  the  part  which  alone  is  represented  in  the  brains 
of  the  lower  vertebrates.  The  higher  intellectual  faculties 
on  the  other  hand  are  the  latest  acquired  and  are 
connected  with  the  anatomically  highest  and  last 
developed  parts  of  the  brain.  Intermediate  between 
these  come,  in  the  order  of  development,  the  sensory 
and  skilled  motor  functions  (and  their  nerve  centres). 

Blunting  of  self-criticism  by  alcohol. 

Now,  of  all  the  intellectual  functions,  that  of  self- 
criticism  is  the  highest  and  latest  developed,  for  in  it  are 
combined  the  functions  of  critical  judgment  and  of  self- 
consciousness,  that  self-knowledge  which  is  essential  to 
the  supreme  activity  we  call  volition  or  the  deliberative 
will.  It  is  the  blunting  of  this  critical  side  of  self- 
awareness  by  alcohol,  and  the  consequent  setting  free  of 
the  emotions  and  their  instinctive  impulses  from  its 
habitual  control,  that  give  to  the  convivial  drinker  the 
aspect  and  the  reality  of  a  general  excitement. 

In  the  mature  well-developed  mind,  this  interplay 
of  thought  and  emotion  goes  on  under  the  checking 
and  moderating  influence  of  self-criticism ;  in  social 
intercourse  especially,  it  is  constantly  checked  by  the 
thought  of  the  figure  one  cuts  in  the  eyes  of  one's  fellow 
men.  In  proportion,  then,  as  alcohol  hampers  this 
mechanism  of  self-control,  the  liberation,  of  intellectual 


00 


or  emotional  effects  goes  on  at  a  higher  rate.  Normally 
the  emotional  states  of  anxiety,  care  and  despondency 
are  maintained  by  self-consciousness,  by  the  repeated 
turning  of  the  stream  of  thought  to  the  self,  its 
difficulties,  its  embarrassments,  the  snares  and  dangers 
that  beset  its  course  on  every  hand,  and  are  far  more 
frequently  imagined  and  foreseen  than  actually  en- 
countered. Hence,  when  imaginative  self  -  conscious- 
ness is  dimmed,  the  emotions  of  this  class  are  pro- 
portionately less  liable  to  be  touched  to  life,  and  in  the 
absence  of  their  restraining  influence,  the  other  emotions 
run  riot  the  more  gaily. 

Weakening  of  self-control  evident  in  every  stage  of  drunken- 
ness ;  most  prominent  feature  of  initial  stage. 

Both  introspectively  and  objectively  this  lack  of  self- 
control  is  clearly  discernible  in  every  stage  of  alcoholic 
intoxication.  It  is  commonly  counteracted  in  part  by 
the  subject  who  becomes  aware  of  it  by  means  of  a 
deliberately  increased  effort  of  self-control ;  but,  as  the 
influence  of  the  alcohol  increases,  this  effort  ceases  to  be 
continuously  effective,  and  the  drinker  surprises  the 
observer  (whether  himself  or  another)  by  smiling  or 
laughing  aloud  at  some  very  small  joke,  or  hy  remarks 
or  other  actions  which  betray  the  suspension  of  his 
habitual  self-control.  And  the  weakening  of  his  critical 
self-awareness  is  especially  revealed  by  the  fact  that  such 
jovial  remarks  as  he  now  utters  seem  to  him  to  shine 
with  a  lustre  hardly  perceptible  to  the  normal  mind ; 
hence  the  tendency,  perhaps  the  most  characteristic  and 
constant  feature  of  the  first  stage  of  drunkenness,  to 
flippant  whimsical  utterances,  which,  like  the  rest  of  the 
subject's  behaviour,  betray  the  blunting  of  his  critical 
self-consciousness  and  of  his  sense  of  personal  responsi- 
bility. 

The  successive  stages  or  phases  of  intoxication  cannot 


34 

be  sharply  distinguished,  and  ever}7  case  presents  its 
peculiar  combination  and  succession  of  features,  varying 
with  the  temperament  and  disposition  and  character  of 
the  individual  and  his  circumstances  of  the  moment. 
But  three  main  stages  may  be  broadly  distinguished 
corresponding  to  the  invasion  by  the  narcotic  of  the  three 
principal  levels  of  cerebral  function  mentioned  above. 
The  first  stage,  that  in  which  the  highest  or  intellectual 
brain  level  is  alone  distinctly  affected,  has  been  described 
above. 

Nervous  Junctions  involved  in  second  stage  of  drunkenness. 

The  second  stage  is  that  in  which  the  functions  of  the 
intermediate  level,  sense  -  perception  and  skilled  move- 
ment, are  invaded  and  disturbed.  The  drinker  begins  to 
shew  a  certain  clumsiness  of  behaviour.  If  he  is  self- 
observant,  he  notices  that  he  is  liable  to  make  ill-adjusted 
movements  ;  on  setting  down  his  glass  it  makes  a  more 
violent  contact  with  the  table  than  he  had  intended ;  on 
rising,  he  may  stumble  against  a  chair,  perhaps  upsetting 
it ;  on  lighting  a  cigarette  he  may  break  the  match  which 
he  essays  to  strike ;  in  speaking  he  may  slur  a  word  or 
drop  an  h.  Each  such  little  mishap  will  at  first  be 
quickly  rectified,  for  each  one  may  evoke  the  power, 
possessed  in  some  degree  by  all  and  to  a  wonderful 
degree  by  many  men,  of  temporarily  correcting  by  an 
effort  of  concentration  or  self-control  the  paralysing 
effects  of  the  drug. 

Emotional  instability  in  second  stage  of  drunkenness. 

At  this  stage  also  his  perceptions  are  impaired.  His 
field  of  sense-observation  is  narrowed ;  the  several  senses 
work  in  relative  isolation  from  one  another ;  the  fineness 
of  his  ear,  of  his  taste,  his  touch,  his  vision  is  blunted ; 
he  may  momentarily  see  objects  doubled,  and  becomes 
relatively  indifferent  to  heat  and  cold,  to  the  flavour  of 


35 

his  food  and  the  aroma  of  his  wine,  to  the  glare  of  the 
lights,  the  strains  of  the  music,  and  the  stridency  of  his 
own  or  his  neighbour's  voice.  The  impairment  of 
his  intellectual  functions  being  further  advanced  than 
in  the  first  stage,  and  the  functions  of  the  third  or 
lowest  cerebral  level,  that  of  the  emotions  and  instinctive 
impulses,  being  still  relatively  intact,  he  is  apt  to  give  way 
to  clumsy  but  violent  displays  of  emotion  characterised 
by  the  exclusive  dominance  of  each  primary  emotion  in 
turn  ;  and  he  passes  quickly  from  anger  to  affection, 
from  boisterous  merriment  to  tears,  from  elated  boasting 
to  despondency,  each  unrestrained  and  unmodified  by 
that  blending  of  other  emotions  which  expresses  the 
reaction  of  the  intellectual  faculties  upon  them. 

At  this  stage  the  drinker  is  apt  to  feel  that  his  bodily 
movements  occur  without  his  initiation  or  intention — 
the}'  escape  from  him  rather  than  proceed  from  his  will 
— and,  in  so  far  as  he  remains  self-conscious,  he  leads  a 
double  life;  his  inner  self,  a  detached  observer  with 
folded  hands,  watches  his  bodily  actions,  not  seldom 
with  surprise,  consternation  or  amusement ;  he  ma}',  e.g. 
become  aware  of  wearing  facial  expressions,  of  making 
gestures,  or  of  uttering  remarks,  which  he  did  not  intend 
and  cannot  wholly  repress,  but  which  seem  to  him  to  be 
executed  by  his  members  of  their  own  initiative. 

At  this  stage  the  paralysis  of  the  drinker's  higher 
mental  functions  reveals  itself  clearly  also  in  the 
increasing  dependence  of  all  mental  and  bodily  activity 
upon  external  stimulation ;  he  lives  in  and  for  the 
present  moment  only,  and,  if  he  is  deprived  of  the 
stimulus  of  social  intercourse,  he  quickly  lapses  into 
dreamy  somnolence  or  actual  sleep. 

Third  stage  of  drunkenness. 
In  the  third  stage,  the  intellectual  processes  of  judgment 
and  self-criticism  and  control  are  virtually  suspended  ; 

16392  d 


36 

the  functions  of  sense-perception  and  skilled  movement 
are  grossly  impaired,  and  the  emotional  tendencies 
themselves  are  invaded  and  weakened,  so  that  only 
strong  appeals  to  them  suffice  to  evoke  any  response  and, 
in  their  absence,  the  drinker  sinks  inert  and  nerveless 
into  a  heavy  sleep,  which  lasts  until  the  alcohol  absorbed 
by  the  nervous  system  has  been  oxidised  or  carried 
away  in  the  blood  and  consumed  by  other  tissues. 

Hypothesis  that  alcohol  ads  primarily   on    nerve-cell  junc- 
tions^ or  synapses. 

This  succession  of  events  constituting  the  normal 
course  of  alcoholic  intoxication  as  it  appears  to 
common  observation,  can  be  explained  in  general 
terms  by  an  hypothesis  as  to  the  direct  action  of 
alcohol  on  the  nervous  tissue,  which  is  suggested  and 
supported  by  many  physiological  facts  and  analogies ; 
the  hypothesis,  namely  that  alcohol  acts  primarily  and 
most  powerfully  not  upon  the  nerve  cells  or  fibres,  but 
upon  the  junctions  between  nerve-cells,  technically 
known  as  synapses.  It  is  now  pretty  well  established 
that  we  may  properly  regard  the  nervous  system  as 
consisting  of  a  vast  number  of  vital  units,  the  nerve- 
cells,  each  consisting  of  a  central  body  and  one  or 
more  slender  threads  or  fibres ;  each  cell  having  no 
anatomical  but  only  a  functional  continuity  with  others. 
Their  relations  to  one  another  may  be  likened  to  those 
of  a  crowd  of  people,  in  which  each  person  maintains 
relations  with  his  fellows  and  communicates  with  them 
only  by  the  touch  of  hands  and  feet.  There  is  much 
evidence  to  shew  that  these  points  of  contact  are  the 
weak  points  of  the  nervous  pathways  ;  the  points  that 
give  way  most  readily  under  strain  or  shock  and  under 
the  influence  of  fatigue  and  of  various  paralysing 
drugs. 


Why  effects  of  alcohol  are  first  shewn  on  higher  functions. 

Further,  there  is  good  reason  to  believe  that  in  the 
pathways  of  the  lower  levels  of  the  brain,  those  which 
subserve  the  functions  first  developed  in  the  race  and 
in  the  individual,  the  points  of  junction  are  relatively 
firm  and  open  to  the  passage  of  the  nervous  current ; 
while  those  of  higher  and  later  developed  levels  are  less 
solidly  organised,  and  that  they  therefore  offer  more 
resistance  to  the  passage  of  the  nervous  current,  in 
proportion  as  they  stand  high  in  the  scale  of  function 
and  late  in  the  order  of  development.  If  we  accept 
this  view,  and  if  we  make  the  further  simple  assump- 
tion that  alcohol  acts  equally  upon  all  such  junction? 
of  nerve-cells  (or  synapses),  we  have  the  explanation 
of  the  phenomena  of  drunkenness.  For,  by  the  terms  of 
the  hypothesis,  the  alcohol,  acting  equally  upon  all  cell- 
junctions  in  the  nervous  system  to  increase  their 
resistance  to  the  passage  of  the  nervous  current,  will 
first  raise  this  resistance  to  the  point  of  impermeability 
in  those  junctions  in  which  it  is  normally  highest, 
that  is, '  in  the  latest  developed  paths  of  highest  func- 
tion ;  and  it  will  progressively  effect  a  similar  paralysis 
of  other  nerve-paths  in  the  descending  order  of 
functional  dignity  and  complexity. 

Action  of  alcohol  purely  narcotic. 

It  may  be  added  that  a  review  of  the  many  laborious 
attempts  made  in  recent  years  to  determine  by  the 
methods  of  the  laboratory  the  effects  of  alcohol  on  the 
mind  and  nervous  system,  shews  that  such  observations 
harmonise  well  with  these  general  conclusions ;  for, 
although  some  of  the  earlier  workers  on  these  lines 
believed  they  had  found  evidence  of  an  initial  stimulating 
effect  of  alcohol,  this  appeared  in  all  cases  to  be  of  but 
small  extent  and  duration  ;  and  later  work  throws  doubt 
upon  the  validity  of  this  interpretation  of  the  evidence 


33 

and  supports  the  conclusion  that  the  direct  effect  of 
alcohol  upon  the  nervous  system  is,  in  all  stages  and  upon 
all  parts  of  the  system,1  to  depress  or  suspend  its  func- 
tions, that  it  is,  in  short,  from  first  to  last  a  narcotic 
drug. 

Varieties  of  mental  symptoms  in  drunkenness. 

If  we  have  truly  stated  the  principle  according  to  which 
alcohol  attacks  the  functions   of   the  brain   and    of   the 
nervous   system  generally,  it  will  be  seen  that  mental 
changes  are  naturally  among  the  first  of  all  the  symptoms 
of  derangement  to  appear.     With  small  doses  of  alcohol, 
they  may  be  the  only  symptoms  which  are  noticeable  ; 
with  larger,  they  are  the  earliest  of  the   whole  sympto- 
matic  train    of    changes.     It    is    obvious    that    though 
traceable  by  psychological  analysis  to  one  single  source, 
namely  the  blunting   of   that   intellectual  self-criticism 
and  control  which  the  mind  normally  exerts,  the  detailed 
lorms    which    they    assume    will,   under   the   manifold 
varieties  of  individual  circumstance  and  character,  appear 
as   disordered   items   of   behaviour    almost    Protean    in 
shape   and   kind.     Yet    of    these,    various    as   they   are, 
certain  sub -types  appear  with   such  frequency,  and  have 
been  so  accreditably  documented  in  carefully  conducted 
test  experiments,2  as  to  be  worth  specific  mention  here, 
since  they  can  be  regarded  as  established  marks  sympto- 
matic  of    alcoholic   effect.     In    this   respect   they   have 
therefore  some  practical  importance.     They  may  be  sub- 
sumed  briefly  thus :    (i)    Uncritical    self-satisfaction   of 
the   subject   with   his   own  performances,   (2)   disregard 

1  For  a  possible  exception  to  this  statement,  in  the  case  of  the 
nerve  centres  of  respiration,  see  pp.  69-70. 

2  Kraex->elin.  t'bcr  die  Beeinflussung  einfacher  psycbischer 
Vorgange  durch  einige  Arzueinrittel.  Jena,  1893.  Rivers. 
Influence  of  Alcohol  and  other  Drugs  on  Fatigne.  London, 
1907.  Partridge.  Studies  in  the  Psychology  of  Intemperance. 
New  York,  1912. 


39 

of  occurrences  and  conditions  normally  evoking  caution 
of  act  and  word,  (3)  trespass  of  rules  and  conventions 
previously  respected,  (4)  impaired  appreciation  of  the 
passage  of  time,  (5)  loquacity  and  (6)  an  argumentative 
frame  of  mind. 

Early  appearance  of  purely  mental  effects  of  alcohol. 

These  changes  of  mentality  actually  observed  in  labora- 
tory experiments  directed  toward  study  of  alcoholic 
effect,  are  largely  confirmed  by  general  experience.  As 
laboratory  experiments  shew,  they  may  occur  when  the 
dose  and  degree  of  action  of  the  alcohol  are  quite  in- 
sufficient to  cripple  manifestly  and  openly  the  power  to 
perform  routine  technical  operations,  such  as  adding 
figures  or  typewriting  by  a  person  accustomed  to  perform 
them.  To  attempt  to  specify  the  lower  limit  of  dose 
required  to  produce  these  symptoms  is  probably  of  little 
value.  Not  only  is  there  varying  susceptibility  to  alcohol 
from  person  to  person,  and  not  only  does,  in  one  and  the 
same  person,  the  susceptibility  differ  according  to  circum- 
stances, digestive  and  other,  under  the  same  dose,  but 
intellectual  self-criticism  and  control  are  strong  in  one 
person,  weak  in  another,  and,  in  the  same  person,  while 
strong  in  respect  of  certain  kinds  of  acts,  may  be  weak 
in  respect  of  certain  others.  With  large  doses  these 
slighter  mental  effects  are  part  of  the  train  of  symptoms 
passed  through  as  profounder  degrees  of  intoxication  are 
approached. 

Disturbance  of  higher  mental  functions  in  conditions  falling 
short  of  drunkenness. 
But  a  point  of  greater  practical  importance  is  that, 
without  signs  of  intoxication  in  the  full  ordinary  or  in 
the  legal  sense  of  the  term,  the  bearing  and  individual 
attitude  of  mind  suffer  temporary  change  as  an  effect  of 
the  drug;  and  those  in  contact  with  the  person  so 
affected  have  for  the  time  being  to  deal  with  an  altered 


4o 

individual,  whose  mind  lacks  temporarily  its  normal 
factor  of  judgment  and  conspicuous  elements  of  its  self- 
control. 

There  is  hardly  any  need  to  emphasise  here  the  obvious 
fact  that  the  directions  which  these  alterations  tend  to 
take  commonly,  even  as  instanced  merely  by  the  few  sub- 
types of  deviation  of  judgment  and  behaviour  just  men- 
tioned, are  likely  to  be  fraught  with  serious  consequences 
for  the  due  discharge  of  responsibilities  in  all  walks  of 
practical  life.  Accuracy,  avoidance  of  accidents,  tactful 
handling  of  colleagues  and  subordinates,  observance  of 
discipline,  punctuality,  reticence  in  matters  of  confidence, 
are  all  obviously  jeopardised;  and  an  additional  source  of 
friction  is  brought  to  complicate  the  relations  between 
the  employer  and  the  employed. 


4i 


CHAPTER  IV. 

alcohol    and    the    performance    of 
Muscular    Acts. 

Complexity  of  muscular  acts. 

The  effect  produced  by  alcohol  on  the  performance  of 
muscular  work  is  not  so  readily  determinable  as  might  at 
first  sight  appear.  The  performance  of  a  muscular  act 
even  of  a  simple  kind  involves  a  number  of  processes. 
The  actual  contraction  of  the  muscle  is  only  the  final  step 
in  a  series  of  events.  The  action  of  the  muscle  has 
invariably  to  be  called  forth  by  recurrent  nervous  action, 
and  this  nervous  action  includes,  even  in  the  simplest 
voluntary  act,  a  linked  series  of  processes  with  which 
many  parts  of  the  nervous  system  are  concerned. 

Influence  of  alcohol  on  their  performance  due  to  action   on 
nervous  system,  and  not  on  muscles. 

The  muscle  being  the  final  executant  of  the  act,  a  point 
desirable  of  elucidation  is  how  far  the  administration  of 
alcohol  influences  directly  the  functioning  of  the  muscles 
themselves.  The  muscles  differ  sufficiently  from  the 
organs  of  the  nervous  system  to  make  it  probable  that 
the  influence  of  alcohol  on  the  two  will  not  be  the  same, 
at  least  not  of  the  same  magnitude. 

The  influence  of  alcohol  upon  muscles  separated  from 
the  nervous  system  has  been  examined,  and  it  has 
been  found  that  when  administered  to  them  through 
the  blood  in  doses  up  to  the  equivalent  of  about  70  cubic 
centimetres  in  man  or  nearly  5  oz.  of  whisky  at  proof 
strength,1  alcohol  produces  no  obvious  effect  upon  the 
contractile  power  or  other  functional  properties  of  muscle. 

JV.  Furth  and  C.  Schwarz,  Pfliiger's  Archiv,  f.  d.  ges.  Physio- 
logic, Vol.  129,  p.  525.     1909. 


42 

We  may  infer  then  that  any  influence  which  alcohol,  in 
such  doses  as  are  met  with  in  ordinary  human  consumption 
of  it,  exerts  upon  the  performance  of  muscular  acts,  must 
be  referred  to  its  effects  upon  the  nerve  centres  concerned 
with  activating  the  muscle. 

Reflex  acts  and  volitional  acts. 

In   regard  to  the  nervous  processes  which  find  their 
expression  in  muscular  acts,  they  are  divisible  into  two 
main  kinds.     Those  of  one  kind  are  termed  volitional, 
because  produced  at  the  behest  of  the  will ;  of  the  other, 
involuntary,    because    independent    of    the    will.      The 
former,  even  at  their  simplest,  are  complex.     The  latter, 
often  spoken  of  as  "  reflexes,"  are  less  so.     These  latter 
are    for    this    reason    more    completely   understood    and 
analysed ;    the    nervous    events    involved    in    them  are 
sufficient^  known  to  serve  as  standards   by  which  the 
effect  of  alcohol  upon  certain  fundamental  processes  of 
nervous  activity  can  be  gauged.    The  relative  simplicity 
of   the  reflexes  has  made  it  possible  for  medical   study 
to  ascertain   with   exactitude   what  parts  and  elements 
of  the  nervous   system    are    required    for    their    perfor- 
mance and  to   judge    from    them    whether    those    parts 
are  working  well  or  ill.     Changes  in   them    give    fairly 
precise    information    as    to    the    seat    and    manner    of 
any  improvement  or  impairment  they  may  shew.     They 
are  of  importance  further  since  it  is  by   means    of    the 
nervous  centres  which  the  reflex  acts  use  that  volitional 
nervous    acts,    initiated    in    the  higher  nervous  centres, 
exercise    their    effect    upon    their    executant     muscles. 
Skilled   movements   of   hand  and   arm,    executed  under 
the  mandate  of  the  will,  demand  for  their  performance 
the  employing  by  the  brain  of  those  same  lower  centres 
which  the    reflexes  of   the  limb  employ  and  test.     The 
brain  centres  bring  the  muscles  into  action  through  the 
lower  reflex  centres, 


43 

If  for  some  part  of  the  body,  say  leg  or  eye,  these 
latter  are  deranged,  it  is  not  to  be  expected  that  the 
skilled  execution,  by  that  part,  of  acts  under  the  behest 
of  the  will  can  continue  to  be  perfect  or  normal. 

Influence  of  alcohol  on  simple  reflex  action, 
(i)  The  knee  jerk. 

A  simple  reflex  act,  much  used  by  the  physician  for 
testing  the  healthy  working  condition  of  the  spinal  cord,  is 
the  knee-jerk.  A  light  tap  is  dealt  to  the  front  of  the  knee 
just  below  the  knee  cap,  on  the  tendon  of  the  muscle  that 
straightens  the  knee.  The  tap  is  delivered  at  a  time  when 
the  limb  is  at  rest,  for  instance  when  the  knee  is  passively 
resting  crossed  upon  the  other  knee.  This  light  blow 
stretches  slightly  and  briefly  the  muscle,  and  this  slight 
stretch  excites  nerve-fibres  which  pass  from  the  muscle  to 
the  nerve-centres  in  the  spinal  cord,  and  so  excites  these 
centres.  The  centres  in  their  turn  excite  the  muscle  by 
means  of  the  motor  nerve  passing  from  them  to  it.  This 
causes  the  jerk-like  movement  of  the  knee.  This  reaction 
tests  therefore,  (i)  the  nerves  passing  from  the  muscle  to 
the  spinal  centres  and  from  the  latter  to  the  muscle  ; 
(ii)  the  spinal  centres  themselves ;  and  (Hi)  the  muscle. 
It  gives  reliable  indications  not  only  of  the  healthy  or 
disordered  condition  of  these  parts  but  in  several  respects 
also  of  the  condition  of  the  brain  itself  as  influencing 
that  of  the  spinal  cord.  The  indications  it  yields  are  the 
more  valuable  because  it  is  a  reflex  which  lies  beyond 
the  voluntary  control  of  the  person  examined.  It  cannot 
be  quickened  or  slowed,  increased  or  diminished  at  will 
by  the  person  experimented  on. 

Experiment  shews  that  a  dose  of  30  cubic  centimetres 
of  alcohol,  equivalent  to  a  little  over  2  oz.  of  whisky  at 
proof,  or  to  about  i\  pint  of  beer  of  average  strength 
(i.e.,  containing  4  per  cent,  of  absolute  alcohol), 
administered  an  hour  to  an  hour  and  a  half  earlier, 
lessens  the  speed  and  amplitude  of  the  movement  of  the 


44 

knee-jerk  in  healthy  persons.  As  an  average  obtained 
from  observations  on  six  men,  this  dose  of  alcohol 
reduced  the  speed  of  commencement  of  the  responsive 
movement  by  q'6  per  cent,  and  diminished  the  extent  of 
the  movement  by  48*9  per  cent.1  A  larger  dose,  45  cubic 
centimetres  of  alcohol,  in  the  same  persons  impaired  the 
reaction  speed  and  amplitude  still  more. 

(zV)   The  u  eye-closing  reflex." 

Another  reflex,  somewhat  less  simple,  is  the  "eye- 
closing  reflex."  The  movement  is  an  involuntary  blink 
which  occurs  when  some  local  danger  imperils  the  eye,  as 
when  grit  enters  it  or  a  blow  threatens  it.  It  commonly 
occurs  also  when  some  startling  shock  is  received  by 
the  body,  or  when  a  loud  sudden  unexpected  noise  is 
heard.  Although  it  is  an  involuntary  act,  repression 
of  it  can  by  practice  and  training  be  acquired  in  regard 
to  circumstances  which  otherwise  regularly  evoke  it. 
Thus,  as  a  response  to  a  threatening  by  a  blow  or  to  a 
sudden  loud  noise,  those  who  are  practised  in  boxing  and 
in  the  use  of  firearms  learn  to  suppress  it. 

The  effect  of  alcohol  on  this  reflex  has  been  examined2 
in  the  same  six  normal  men  whose  knee-jerk  was  tested 
as  above.  The  dose  of  30  cubic  centimetres  alcohol 
retarded  the  reflex  speed  by  5*9  per  cent.,  taking  the 
average  from  four  of  the  men ;  it  decreased  the  eyelid 
movement's  extent  by  107  per  cent.,  taking  the  average 
measure  from  five  of  the  men.  45  cubic  centimetres  of 
alcohol,  equivalent  to  about  3  oz.  of  whisky  at  proof,  or 
to  nearly  2  pints  of  beer,  impaired  the  reflex  still  more. 
In  two  of  the  men  the  smaller  dose  slightly  increased  the 
reflex-speed,  and  in  one  of  these  two  the  larger  dose  also 
ncreased  it.  The  means  used  in  these  observations  for 
evoking  the  eye-blink  reflex  was  the  sudden  production 

1  Dodge  &  Benedict,  Psychological  Effects  of  Alcohol,  Washington, 

I9I5- 

2  Dodge  &  Benedict,  op.  cit.,  1915. 


45 

of  a  loud  urgent  noise.  Both  of  the  men  in  whom  the 
dose  of  alcohol  induced  increase  in  the  speed  of  the  reflex 
were  found  normally  and  apart  from  any  dosage  with 
alcohol  to  exhibit  unusually  small  blink-reflexes.  The 
observers  concluded  that  the  normal  blink-reflex  in  these 
two  men  was  a  partially  restrained  one,  some  degree  of 
inhibitory  control  over  the  reflex  having  been  acquired 
by  them.  One  of  them  was  practised  in  boxing  and 
one  in  revolver  shooting.  The  observers  concluded  that 
the  quickening  of  the  reflex  produced  in  these  two  cases 
by  the  alcohol  was  due  to  the  alcohol  weakening  the 
acquired  inhibitory  control. 

Depressant  effect  of  alcohol  on  simple  reflexes. 
This  dose  of  alcohol,  therefore,  depresses  these  simple 
reflex  reactions  of  the  nervous  system.  Even  in  regard 
to  the  somewhat  greater  frequency  of  the  pulse-rate 
which  commonly  follows  the  administration  of  a  moderate 
dose  of  alcohol,  the  cause  seems  to  lie  in  a  depressant 
rather  than  a  stimulant  action  of  the  drug.  The  accelera- 
tion of  pulse  appears  to  be  due  to  depression  in  degree  of 
the  reflex  cardio-inhibitory  tone  which  normally  restrains 
the  heart-beat.1  The  depression  caused  by  the  alcohol 
in  all  these  instances  indicates  a  specific  lowering  of  the 
powers  of  the  lower  nervous  centres,  of  a  nature  re- 
sembling, though  much  less  in  intensity,  that  produced 
by  chloroform  and  drugs  of  that  kind,  tending  towards 
temporary  paralysis. 

Difficulty  of  analysing  effect  of  alcohol  on  volitional  acts. 
Simple  reflexes  like  the  above  form  a  suitable  starting 
point  for  inquiry  into  any  influence  which  alcohol  may 
exert  upon  the  nervous  system  in  its  performance  of 
muscular  acts.  But  the  step  from  such  simple  reflexes 
to  acts  initiated  and  controlled  by  the  will  is  a  consider- 
able one  into  a  region  of  greater  complexity.     Besides  the 

1  Dodge  &  Benedict,  op.  cit.,  1915.     Vide  also  Chapter  VI,  p.  73.  ; 


46 

lower  reflex  centres  through  which  the  volitional  processes 
must  ultimately  play,  the  nerve-centres  concerned  in 
calling  forth  and  directing  a  muscular  act  at  behest  of  the 
will  are  many,  some  in  the  highest  parts  of  the  brain  and 
others  in  the  lower,  and  some  in  the  spinal  cord  itself. 
It  is  impossible  to  track  the  influence  of  alcohol  step  by 
step  through  such  a  maze.  But  it  can  be  said  with 
certainty  that  the  degree  of  action  of  the  alcohol  will  not 
appear  equally  in  all  the  centres  nor  in  all  the  phases  of 
their  processes.  The  detailed  nature  of  the  normal  inter- 
action of  the  various  centres,  whence  the  willed  muscular 
act  results,  is  far  from  being  as  yet  sufficiently  known  to 
justify  here  an  attempt  to  analyse  the  influence  of  alcohol 
in  regard  to  the  steps  of  the  process  taken  piecemeal. 

Effect  of  alcohol  on  efficiency  of  willed  movements. 

Experiments  have  however  been  made  which,  without 
attempting  to  analyse  the  willed  act,  and  accepting  the 
movement  made  as  index  of  its  success,  indicate  how  its 
efficiency  changes  with  varying  conditions.  Three  main 
directions  in  which  the  efficiency  may  vary  are  (i)  in 
power,  (2)  in  ability  to  withstand  fatigue,  and  (3)  in 
nicety  of  adjustment  for  the  object  in  view.  The  power 
of  a  muscular  act  and  its  ability  to  withstand  fatigue  can 
be  examined  by  the  ergograph.  This  instrument  registers 
the  strength  and  extent  of  a  particular  willed  movement 
which  can  be  easily  repeated,  the  instrument  continuing 
its  register  throughout  a  series  of  repetitions  of  the  act. 
The  movement  arranged  for  is  purposely  kept  a  very 
simple  one,  and  therefore  little  scope  is  given  in  the 
ergograph  for  examination  of  nicety  of  adjustment,  or 
other  factors  which  constitute  "  skill." 

Ergographic  experiments  on  the  effect  oj  alcohol. 

The  influence  of  alcohol  has  been  examined  ergo- 
graphically  by  many  observers.    Some  of  the  observations 


47 

appear,  however,  to  be  of  small  value  for  our  purpose  ;  in 
some  the  dose  of  alcohol  is  unstated  ;  in  some  the  form  of 
ergograph  was  unsatisfactory  ;  in  some  too  little  heed 
was  paid  to  circumstances  other  than  the  giving  of 
alcohol  likely  to  influence  the  muscular  act  under  the 
conditions  of  the  experiment.  The  earlier  obser- 
vers, impressed  with  the  simplicity  of  the  actual 
movement  employed  as  an  index,  did  not  appre- 
ciate fully  the  extent  to  which  mental  conditions 
might  affect  it.  Experience  with  ergographic  records 
has  shewn  that  fleeting  states  of  the  mind,  greater  or 
lesser  concentration  of  attention,  or  greater  or  lesser 
interest  in  the  repetition  of  the  movement  at  one  time 
than  at  another,  may  influence  quite  distinctly  a  person's 
performance  of  a  movement  even  so  simple  as  that  chosen 
for  the  ergograph.  Mental  "suggestion"  has  to  be 
excluded  so  far  as  possible  from  disturbing  the  subject's 
attitude  toward  the  experiment,  which  should  be  a 
neutral  attitude.  The  mere  knowing  that  he  has  or  has 
not  received  a  dose  of  alcohol  may  affect  his  performance 
under  the  test  and  obscure  or  confuse  any  effect  produced 
by  the  alcohol  itself. 

The  researches  in  which  precautions  have  been  taken 
definitely  to  safeguard  against  these  various  sources  of 
error  are  still  relatively  few,  and  notable  among  them  is 
the  investigation  by  Rivers.1  Rivers  found  that  single 
doses  of  5,  of  10,  and  of  20  cubic  centimetres  of  alcohol  left 
no  indubitable  trace  upon  the  muscular  act,  as  recorded 
by  the  ergograph.  His  experiments  were  carried  out  upon 
two  persons.  When  the  dose  was  increased  to  40  cubic 
centimetres,  corresponding  to  over  2|  oz.  of  whisk)-,  or  to 
about  1 J  pint  of  beer,  an  effect  was  produced  on  one 
of  these.  That  person  was  habitually  an  abstainer  from 
alcohol.     The  effect  produced  on  his  ergograph  record 

Rivers.     Influence  of  Alcohol  and  other  Dru^s  on  Fatigue. 
London.     1907. 


48 

was  increase  in  the  series  of  contractions  performed,  this 
increase  appearing  about  an  hour  and  a  half  after  the 
administration  of  the  dose.  The  increase  was  small. 
On  the  other  person  examined  the  dose  of  40  cc.  was 
followed  by  slight  decrease  of  the  ergographic  work,  but 
Rivers  was  not  satisfied  that  in  the  case  of  this  person 
the  dose  produced  any  clearly  indubitable  effect. 

The  result  stands  in  general  conformity  with  results 
obtained  previously  by  Oseretzkowsky  and  Kraepelin1, 
who  found  no  obvious  evidence  of  an  effect  of  alcohol 
on  the  ergographic  record  after  administration  of  a  single 
dose  of  50  cubic  centimetres  (i.e.,  3^  oz.  of  whisky  or  a 
little  over  2  pints  of  beer).     . 

In  the  extensive  series  of  ergographic  experiments 
by  Hellsten2,  the  ergograph  employed  was  of  an 
unusual  type,  the  movement  registered  being  executed 
with  both  arms,  and  therefore  not  so  limited  and  simple 
as  is  generally  preferred  for  ergographic  examination. 
Working  with  this  type  of  ergograph,  Hellsten  tested  the 
influence  of  alcohol  upon  its  records.  The  subject  of 
experiment  was  an  athlete  of  90  kilos  (between  14  and 
15  stone)  weight.  Single  doses  of  25  and  of  50  cubic 
centimetres  of  alcohol,  given  in  appropriate  dilution  with 
water  5-10  minutes  before  the  ergographic  record  began, 
produced  no  clear  and  unequivocal  effect  on  the  record. 
When  the  dose  was  80  cubic  centimetres,  corresponding 
to  between  5  and  6  ounces  of  whisky,  or  more  than 
3  pints  of  beer,  there  ensued,  after  a  slight  and  brief- 
lasting  improvement  in  the  record,  a  marked  decrease  in 
the  recorded  muscular  work.  When  this  dose  preceded 
the  test  by  half  an  hour,  the  decrease  observed  amounted 
to  20  per  cent,  of  the  normal  performance  done  without 

1  Oseretzkowsky   n.   Kraepelin,  in  Psychologische  Arbeiten, 
Vol.  3,  pt.  4,  p.  587.     1901. 

j.2  Hellsten.  Skandinav.  Archiv  f.  Physiologic  Vol.  16,  p.  160. 
1904. 


49 

alcohol.  The  decrease  was  17  per  cent,  when  the  dose 
preceded  the  test  by  one  hour,  and  was  1 1  per  cent,  when 
it  preceded  the  test  by  twTo  hours. 

Animal  experiments  to  test  effect  of  alcohol  on  work. 

Comparable  in  some  measure  with  the  above  experi- 
ments are  those  carried  out  by  Chauveau,1  who  examined 
the  influence  of  alcohol  upon  the  output  of  work  by  a  trained 
dog  turning  a  treadmill.  The  dog  had  a  measured  and 
liberal  daily  ration  of  raw  meat  and  cane-sugar.  When  one- 
third,  namely  84  grammes,  of  the  daily  sugar  ration  was  re- 
placed by  50  cubic  centimetres  of  alcohol  the  output  fell  by 
about  22  per  cent.  Similar  results  were  obtained  whether 
the  alternation  of  the  rations  followed  weekly  or  monthly. 
The  dog  lost  wreight  on  the  alcohol  substitution  ration  and 
maintained  its  weight  on  the  ration  without  alcohol. 
The  actual  weight  of  the  dog  is  not  stated,  but  the  daily 
amount  of  alcohol  taken  by  it  in  the  substituted  ration 
must  have  been  equivalent  to  not  less  than  250  cubic 
centimetres  alcohol  for  a  man,  or  not  much  short  of  a 
pint  of  whisky.  This  animal  is,  however,  less  susceptible 
to  alcohol  than  is  man. 

Observations  on  effect  of  alcohol  on  efficiency  in  hill- climbing. 

Comparable  also  to  some  extent  with  these  observa- 
tions on  the  dog  are  observations  by  Diirig2  upon  man. 
Diirig  observed  the  effect  of  alcohol  upon  the  muscular 
exercise  involved  in  walking  to  the  top  of  a  hill.  The 
ascent  and  the  route  taken  and  the  time  of  day  and  other 
conditions  of  the  ascent  were  kept  as  far  as  practicable 
the  same  for  a  number  of  successive  repetitions,  with  the 
exception  that  on  some  days  30  cubic  centimetres  alcohol 
in  150  cubic  centimetres  of  water,  i.e.,  as  much  alcohol  as 

1  Chauveau  Cornptes  rendus  de  l'Academie  des  Sciences.  Vol. 
132,  pp.  65  and  no.      1901. 

2  Diirig.  Pfliiger's  Archiv  fur  die  ges.  Physiologic  Vol.  113, 
p  314.     1906. 


5© 

is  contained  in  2  oz.  of  whisk}7  or  ij  pint  of  beer,  was 
taken  in  addition  to  the  daily  ration.  This  dose  was  taken 
at  breakfast  just  before  starting.  It  was  found  that 
although  the  walker,  who  was  accustomed  to  moderate 
use  of  alcohol,  felt  in  himself  no  difference  between  his 
condition  on  the  alcohol  and  non-alcohol  days,  the  distance 
and  ascent  per  minute  was  on  the  alcohol  days  less  by 
12-14  per  cent,  than  that  on  the  non-alcohol  days.  This 
was  so,  although  the  expenditure  of  energy  by  his  body 
was  greater  on  the  alcohol  days  than  on  the  non-alcohol 
days.  Durig  inclined  to  attribute  this  deterioration  in  the 
performance  of  the  ascent  to  impairment  of  skill  with 
which  movements  are  directed.  He  says  that  it  was  as  if 
the  effect  of  previous  training  in  the  act  were  temporarily 
lost.  The  experienced  climber  is  reduced  by  the  dose  of 
alcohol  towards  the  level  of  a  beginner  at  such  work  and 
makes  an  unduly  large  number  of  badly  directed  or 
ill-judged  movements.  In  short,  alcohol  in  a  dose  of 
30  cc.  tended  to  undo  the  effect  of  previous  training. 
The  act  here  was  of  course  much  more  complex  and  gave 
much  more  scope  for  skill  than  the  acts  examined  by  the 
ordinary  ergograph. 

Disturbing  effect  of  alcohol  on  skilled  movements. 

Rivers,  in  an  appendix  to  the  account  of  his  ergographic 
observations,  notes  that,  although  the  ergographic  records 
shewed,  even  when  the  dose  of  alcohol  was  40  cubic  centi- 
metres, slight  evidence  only  of  their  being  influenced  by  it, 
there  was  from  the  experiments  other  evidence  to  the  effect 
that  after  that  dose  "  the  control  of  movement  did  not 
appear  to  be  so  good,"  and  that  the  execution  of  movements 
tended  to  be  slower  than  usual.  His  evidence  for  this  is 
as  follows: — "In  the  normal  condition,"  i.e.  of  the  sub- 
ject experimented  with,  ''the  two  minutes  allowed  him 
between  successive  ergograms  for  taking  the  customary 
readings  and  for  making   necessary  adjustments  of  the 


5i 

ergograph  were  ample  for  his  doing  so ;  but  ou  the 
40  cc.  alcohol  days  the  period  of  2  minutes  was  hardly 
long  enough  for  him  to  do  what  was  necessary,  although 
the  time  it  took  him  seemed  to  him  no  longer  than  usual. 
This  was  so  striking  that  the  subject  was  at  first  inclined 
to  believe  that  his  watch  was  in  error,  for  it  seemed  to 
him  that  he  had  been  carrying  out  his  usual  task  at 
the  normal  speed." 

"Several  small  accidents  happened  on  days  on  which  the 
dose  of  alcohol  was  40  cc,  and  these  were  probably  the 
result  of  awkwardness  in  adjusting  the  apparatus.  Some 
of  the  intervals "  (between  the  actual  spells  of  exercise 
at  the  ergograph)  "were  occupied"  (by  the  subject)  "in 
drawing  lines  for  tabular  purposes  or  in  pasting 
ergograms  in  a  book,  and  these  operations  were  found 
afterwards  to  have  been  done  roughly  or  irregularly  on 
the  40  cc.  alcohol  days." 

"  Within  half  an  hour  of  the  taking  of  the  40  cc.  alcohol 
there  came  on,"  in  this  subject,  "a  subjective  feeling  of 
lassitude  and  disinclination  for  activity  either  of  body  or 
mind."  "  It  was  doubtful  how  far  the  state  of  lassitude 
was  preceded  by  one  of  exhilaration,  but,  if  the  latter 
occurred,  it  was  certainly  of  very  brief  duration." 
"  During  the  state  of  lassitude  there  was  decided  irrita- 
bility ;  and  a  fellow  worker  states  that  he  was  able  to 
recognise  clearly  the  days  on  which  the  40  cc.  dose  had 
been  taken  by  the  general  demeanour  of  the  subject — 
partly  from  his  lassitude,  partly  from  his  very  obvious 
irritability." 

Effect  of  alcohol  on  adjustment  of  eye- movements. 

Rivers,  therefore,  although  he  found  no  clear  evidence  of 
influence  of  alcohol  upon  the  performance  of  the  muscular 
act  examined  by  his  ergograph  until  the  single  dose  had 
reached  40  cubic  centimetres  and  sometimes  not  then,  con- 
cluded that  that  dose  did  in  one  of  his  two  subjects  impair 

16392  e 


52 

the  execution  of  some  skilled  movements  incidental  to 
those  experiments  but  not  recorded  by  the  ergograph.  This 
stands  in  harmony  with  observations  by  Guillery1  on  the 
influence  of  alcohol  on  certain  movements  of  the  eyes. 
Guillery  tested  the  ability  of  the  e}^es  to  follow  clearly  an 
object  brought  nearer  and  nearer  to  the  person  observing 
it,  that  is  to  keep  both  eyes  focussed  on  it  as  it  approached. 
This  requires  a  convergent  movement  of  the  eyeballs,  the 
convergence  increasing.in  degree  as  the  object  is  brought 
closer.  At  a  certain  closeness  further  convergence  be- 
comes impossible  and  fixation  is  lost,  the  object  no  longer 
appearing  single.  He. found  that  the  degree  of  conver- 
gence possible  for  the  person  was  noi.  affected,  either  in 
the  direction  of  improvement  or  impairment,  by  a  dose  of 
20  cubic  centimetres  alcohol,  equivalent  to  nearly  1^  oz. 
of  whisky,  or  to  over,  f  of  a  pint  of  beer,  but  that  by  a  dose 
of  40  cubic  centimetres  it  was  very  distinctly  impaired.  The 
impairment  took  the  form  of  weakening; and  of  slowing  of 
the  movement.  The  impairment  was  first  detectible  about 
20  minutes  after  the  taking  of  the  dose  ;  normal  speed  and 
power  were  regained  about  40  minutes  later.  With  60  cubic 
centimetres  alcohol  the  impairment  was  greater,  came  on 
about  10-15  minutes  after  the  dose  and  lasted  for  an  hour 
and  a  half.  The  opposite  movement  of  "  divergence  "  was 
impaired  even  more,  and  other  eye  movements  similarly 
examined  were  found  also  to  be  impaired.  Guillery  re- 
marked that  under  no  grade  of  dose  of  alcohol  and  at  no 
time  under  any  dose  were  the  eyeball  movements  found  to 
be  strengthened  or  rendered  quicker. 

Similarly,  Dodge  and  Benedict  found  that  a  dose  of 
45  cubic  centimetres  of  alcohol  measurably  impaired  the 
speed  of  starting  the  movement  of  turning  of  the  eyes  toward 
a  fresh  object :  in  short,  the  speed  of  directing  the  gaze. 
The  whole  movement  is  one  of  considerable  complexity 

1  Guillery.  Pfliiger's  Archiv  fur  die  [ges.  Physiologic  Vol.  79, 
p.  597.     1899. 


of  nervous  adjustment.  The  twelve  muscles  of  the 
eyeballs  have  all  of  them  to  act  appropriately  together, 
that  is  to  say,  some  have  to  be  made  to  contract  more 
than  they  were  contracting,  others  have  to  be  relaxed 
from  contraction,  and  these  changes  have  to  be  made  in 
each  muscle  with  harmonious  rate  and  degree.  To 
execute  the  movement  the  nerve  centres  must  not  only 
have  perfect  control  of  the  necessary  motor  powers  but 
must  be  aware  of  the  posture  the  eyeballs  start  from  and 
of  the  direction  toward  which  they  have  to  be  moved. 
These  latter  requisites  demand  the  alertness  of  sensory 
nerve-centres,  information  from  which  is  a  factor  in  the 
guidance  and  alertness  of  the  motor  centres  themselves. 

The  act  is,  of  course,  one  of  extremely  frequent  execu- 
tion throughout  the  waking  day,  and  from  an  early  period 
of  infant  life  onward.  It  is  indeed  in  many  respects 
a  reflex  act ;  and  it  is  under  many  circumstances 
impossible,  and  under  still  more  very-,  difficult,  of 
repression  by  the  will  ;  it  tends  to  occur  - '"  in  spite  of 
ourselves."  A  form,  however,  in  which  we  meet  its  use  in 
a  highly  practised  technical  act  is  that  trained  movement 
learned  in  reading  which  enables  the  eyes  to  follow  the 
words  across  a  page  and  then  return  correctly  to  the  first 
word  in  the  line  immediately  below.  I/ike  all  other  acts 
of  the  kind  a  slight  delay  attends  its  starting,  a  delay 
which  though  it  is  not  long  is  yet  considerably  longer 
than  the  delay  attending  such  simpler  reflexes  as  the 
knee-jerk.  The  influence  of  alcohol  on  this  delay  has 
been  tested  and  on  the  same  persons  as  those  forming 
the  subjects  of  the  experiments  on  the  simpler  reflexes. 

A  dose  of  45  cubic  centimetres  alcohol  was  found  an 
hour  and  a  half  after  it  had  been  taken  to  increase  the 
delay  (average  of  all  six  men)  by  15  per  cent.  The 
accuracy  of  the  movement,  that  is,  the  degree  of  truth 
with  which  the  eyeballs  when  moved  hit  the  required 
direction,  was  not  tested. 


54 

Effect  of  alcohol  on  speed  of  to  and  fro  movement  of  finger. 

The  same  observers  designed  an  experiment  testing  the 
performance  of  an  act  relatively  simple  in  character  yet 
one  which  is  not  natural!}'  regularly  practised,  namely  a 
rapid  to  and  fro  movement  of  a  finger,  the  person  being 
told  to  move  the  finger  thus  as  rapidly  as  possible. 
The  index  of  success  taken  was  the  speed  with  which 
the  movement  could  be  alternated,  the  rate  at  which  the 
to  and  fro  movements  could  be  made  to  follow  each  other. 
vVhile  requiring  the  action  of  relatively  lowTer  nervous 
centres  the  exercise  demands  therefore  in  addition  some 
effort  of  the  higher  centres  in  controlling  and  urging  the 
former.  It  involves  activity  of  the  will  and,  though  not 
to  a  high  degree,  demands  that  kind  of  effort  which  is 
necessary  for  acquiring  facility  in  a  novel  manoeuvre 
which  habituation  has  not  as  yet  made  easy.  It  is  there- 
fore to  this  extent  a  test  of  skill,  skill  taking  effect  in 
speed.  It  tests,  though  very  simply,  just  that  type  of 
nervous  process  which  is  involved  in  the  first  steps  of 
learning  to  use  a  new  tool  or  attaining  dexterity  in  a  new 
manual  process. 

The  effect  of  alcohol  as  thus  tested  was  examined  in  the 
same  six  men  employed  for  the  "turning  of  the  gaze" 
test.  The  dose  of  45  cubic  centimetres  of  alcohol  taken 
an  hour  and  a  half  previously  reduced  the  rapidity  with 
which  the  movement  could  be  performed  by  8'8  per  cent, 
(average  of  the  six  persons). 

Conclusions. 

It  will  be  seen  that  experiments  suitable  for  yielding 
inferences  for  the  present  purpose  are  not  numerous; 
and  that,  if  for  that  reason  alone,  caution  is  necessary 
111  making  deductions  from  them.  Yet,  the}'  agree  in 
indicating  that  a  single  dose  of  less  than  40  cubic  centi- 
metres of  alcohol,  or  as  much  as  would  be  taken  in  about 
2§  oz.  of  whisky  at  proof,  or  in   if  pint  of  beer,  in  an 


55 

adult  accustomed  to  moderate  use  of  alcohol,  exerts  little 
or  no  appreciable  influence  on  the  performance  by  him 
of  a  muscular  act  of  simple  character  not  demanding 
precision.  For  acts  requiring  skill  the  inference  from 
the  experiments,  so  far  as  they  go,  seems,  however,  to  be 
that  their  performance  tends  to  be  temporarily  impaired 
after  a  dose  of  alcohol  of  even  less  than  40  cubic  centi- 
metres, e.g.  30  cubic  centimetres;  especially  in  diminished 
speed  and  nicety  of  the  required  act's  performance.  It 
seems  therefore  permissible  to  suppose  that  the  greater 
the  precisional  delicacy  and  alertness  demanded  in  a 
muscular  act  and  the  greater  its  degree  of  difficulty,  e.g. 
by  reason  of  novelty  to  the  performer,  the  more  liable  will 
that  act  be  to  shew  impairment  under  the  influence  of 
alcohol,  and,  within  limits,  the  smaller  will  be  the  dose  of 
alcohol  which  may  impair  the  act.  Reliable  evidence  that 
alcohol  improves,  in  normal  circumstances,  the  efficient 
performance  of  any  muscular  act,  .unskilled  or  skilled, 
seems  at  present  to  be  altogether  lacking. 


CHAPTER  V. 

Action  of  Alcohol  on  the  Digestion. 

Factors  in  digestion  which  may  be  influenced  by  alcohol. 

The  process  of  digestion  is  very  complex  and  it  is 
convenient  to  distinguish  the  following  factors  each  of 
which  might  be  modified  by  alcohol. 

(i)  The  secretion,  or  outpouring,  of  the  digestive  juices, 
saliva,  gastric  juice,  pancreatic  juice  and  bile,  which 
may  be  altered  either,  directly,  by  some  action  upon  the 
glands  which  form  the  juices,  or  indirectly,  through 
nerves  which  convey  impulses  leading  to  "alterations  of 
quality  or  quantity  in  the  juices  poured  out. 

(2)  The  churning  movements  of  the  digestive  organs, 
particularly  the  stomach,  movements  which  normally  aid 
digestion  but,  when  abnormal  in  kind  or  degree,  hinder 
it  and  often  cause  pain. 

(3)  The  actual  digestion  or  chemical  transformation  of 
such  food-stuffs  as  undergo  it  and  their  subsequent 
absorption  after  they  have  been  more  or  less  profoundly 
changed  by  the  action  of  the  digestive  juices. 

Effect  of  alcohol  011  secretion  of  digestive  juices. 

Beginning  with  (1)  we  may  first  inquire  in  general 
terms  whether  alcohol  does,  or  does  not,  cause  a  flow  of 
digestive  juices,  and  if  so,  how.  So  far  as  the  saliva  is 
concerned,  there  is  no  doubt  that  alcohol  taken  into  the 
mouth  does,  like  any  other  sapid  fluid,  or  indeed,  like  the 
act  of  chewing  inert  substances  such  as  india-rubber, 
cause  a  flow  of  saliva.  This  action  is  not  of  much 
importance.  So  far  as  the  g as iric  juice  is  concerned,  the 
question  is  more  important  and  the  answer  less  simple. 
Thus,  alcohol  might  cause  a  flow  indirectly,  by  acting 
UDon  nerves  of  taste  or  smell  ;  any  agreeable  taste  in  the 


57 

mouth  is  well  known  to  do  this;  but  we  cannot  say  that 
this  is  peculiar  to  alcohol,  and  the  only  direct  observation 
(upon  a  woman  who  had  an  artificial  opening  in  her 
gullet  and  another  in  her  stomach)  did  not  afford  any 
decisive  information. 

When  alcohol  reaches  the  stomach,  it  certainly  arouses 
a  considerable  secretion  of  a  juice,  partly,  perhaps,  by 
directly  irritating  the  wall  of  the  stomach  but  largely 
through  a  specific  action  on  the  cells  which  manufacture 
the  digestive  juices.  This  has  been  proved  by  many 
experiments  on  animals  and  also  by  observations  upon 
men  who,  in  consequence  of  disease  or  injury,  had  had 
artificial  openings  made  into  their  stomachs  through 
which  alcohol  could  be  introduced,  often  without  the 
patients  knowing  what  had  been  given.  In  animals,  a 
part  of  the  stomach  separated  from  the  main  stomach 
secreted  actively  when  alcohol  was  given  by  the  mouth. 

The  gastric  juice  which  is  secreted  owing  to  the  action 
of  alcohol  is  not,  however,  of  a  normal  kind.  It  contains 
the  usual  amount  of  hydrochloric  acid  but  very  little 
pepsin — the  ferment  which  is  concerned  in  the  digestion 
of  albuminous  substances  by  the  stomach.  In  fact,  all 
the  pepsin  which  the  juice  contains  has  been  merely 
washed  out  of  the  cells ;  no  fresh  supply  is  formed  in 
response  to  the  action  of  alcohol.  It  accordingly  follows 
that  this  increased  amount  of  gastric  juice  is  of  little  or 
no  value  in  the  process  of  digestion,  although  there  is  no 
reason  to  suppose  that  it  is  in  any  way  injurious.  So 
far  as  the  amount  of  secretion  is  concerned,  the  increase, 
in  dogs,  is  greatest  when  small  doses  of  alcohol,  producing 
in  the  stomach  a  concentration  not  higher  than  10  per 
cent.,  are  given.  As  the  amount  and  its  concentration 
increase,  the  rate  of  secretion  falls  off  and  there  is  a 
tendency  to  form  much  slimy  substance  (mucus).  The 
greater  the  amount  and  the  concentration,  the  greater 
the    formation     of     mucus.      When     the     alcohol     was 


58 

repeatedly  given,  even  in  dilute  form,  the  mucus 
secretion  became  more  marked  and  the  increase  of  total 
juice  smaller.  It  is  said  that  the  pancreatic  secretion  is 
also  increased  by  alcohol,  given  by  the  stomach  or  by 
injection  through  the  anus  into  the  large  bowel.  This, 
together  with  the  alleged  increase  in  the  secretion  of  bile, 
may  in  part  be  due  to  some  action  on  the  stomach,  for  an 
increase  of  gastric  secretion  often  leads  to  an  increase  in 
the  activity  of  the  pancreas. 

Action  of  alcohol  on  movements  of  stomach. 

Passing  to  (2),  the  churning  movements  of  the  stomach 
are  a  natural  part  of  the  digestive  process — they  aid 
digestion.  They  aid  it,  not  only  by  promoting  digestion 
in  the  stomach  itself,  but  also  by  duly  passing  on  partially 
digested  food  from  the  stomach  into  the  intestine,  for  the 
completion  of  its  digestion  there.  It  is  commonly  stated 
that  alcohol  promotes  the  movements  of  the  stomach,  but 
the  experimental  methods  by  which  it  has  been  sought  to 
establish  this  conclusion  were  not  altogether  satisfactory. 
Chittenden1,  for  instance,  did  not  find  that  the  stay  of 
food  in  the  stomach  of  a  dog  was  materially  altered  by 
the  presence  of  alcohol.  Carlson2,  who  investigated  the 
movements  of  the  stomach  in  a  man  with  an  artificial 
opening  (fistula)  into  that  organ,  found  that  diluted 
alcohol,  brandy  and  various  wines  introduced  directly 
through  the  fistula,  arrested  the  rhythmical  movements 
and  the  bracing  of  the  muscular  coats  (tonus)  which  are 
associated  with  hunger,  but  saw  no  increase  of  movement. 
50-100  cubic  centimetres  (2-3  ounces)  of  10  per  cent, 
alcohol  were  enough  to  do  away  with  the  hunger  con- 
tractions for  two  hours,  and  200  cubic  centimetres  (half  a 

1  Chittenden,  in  Physiological  Aspects  of  Liquor  Problem,  Vol.  I., 
p.  294  ;  Boston,  1903. 

-  Carlson.    American  Journal  of  Physiology.    Vol.  32,  p.  252,  1913. 


59 

pint)  of  beer  had  this  effect  for  from  half  an  hour  to  an  hour. 
So  far  indeed  as  the  evidence  goes,  it  would  seem  that  there 
is  no  reason  to  believe  that  gastric  movement  is  increased 
by  alcohol  while  some  forms  of  contraction  are  arrested. 
This  lessened  movement  of  the  stomach,  a  so-called 
carminative  action,  is  produced  by  many  other  volatile 
substances,  and  may  explain  the  relief  of  discomfort  and 
colic-like  pains  which  such  substances,  including  alcohol, 
may  afford. 

Effect  of  alcohol  on  activity  of  digestive  ferments. 

Finally,  under  (3),  we  take  first  the  chemical  process 
of  digestion.  It  has  already  been  said  that  the  gastric 
ferment  pepsin  is  not  increased  in  amount  by  alcohol, 
but  its  activity  might  be.  This  is  a  matter  wrhich  has 
engaged  the  attention  of  mam'  investigators  and  their 
general  results  are  concordant.  The  possible  action  in 
this  way  can  be  measured  by  ascertaining  the  amount  of 
change  wrhich  gastric  juice  is  able  to  effect  in  food  with 
wThich  it  is  mixed  in  test  tubes  containing  different  small 
amounts  of  alcohol.  It  has  been  shown  that  while 
1-2  per  cent,  of  pure  alcohol  has  little  effect  upon  the 
activity  of  the  juice,  in  the  presence  of  from  5-10  per 
cent.,  digestion  is  slightly  retarded,  while  a  concentration 
of  more  than  10  per  cent,  very  definitely  diminishes  the 
rate  of  digestion. 

If  the  gastric*  juice  used  contains  but  little  ferment, 
the  retardation  induced  by  even  10  per  cent,  alcohol  is 
considerable.  (Such  a  concentration  can  rarely  if  ever 
be  present  in  the  stomach  of  a  living  man  for  more  than 
a  fewr  seconds.) 

Ordinary  forms  of  spirits  act  on  gastric  digestion  merely 
in  proportion  to  the  amount  of  alcohol  they  contain,  but 
wines,  especially  red  w7ines,  and  sherry,  retard  digestion 
much  more  than  can  be  explained  by  the  alcohol  they 
contain,    evidently  owing  to  the  activity   of    some  other 


6o 

constituents.  The  same  is  true  of  the  beers,  although 
these  in  small  quantities  have  no  pronounced  effect.  The 
above  general  statement  applies  equally  to  the  salivary 
ferment,  viz.,  little  or  no  action  when  the  proportion  is 
low,  retardation  when  the  alcohol  is  stronger  than  10 
per  cent.  Here,  again,  wTines  and  beers  have  a  retarding 
effect  out  of  proportion  to  their  content  of  alcohol,  an 
additional,  and  more  powerful,  factor  here  being  the 
acidity  of  some  wines. 

Although  some  authorities  have  believed  that  the  action 
of  alcohol  upon  pancreatic  digestion  was  less  un- 
favourable than  upon  gastric  digestion,  one  even  stating 
that  the  digestion  of  fats  is  accelerated  by  it,  there  is  no 
doubt  that  some  of  the  ferments  themselves  when 
examined  in  test  tubes,  are  more  sensitive  to  the  action 
of  alcohol  than  are  those  of  the  stomach.  The  digestion 
of  albuminous  substances  may  be  delayed  by  so  little  as 
2-3  per  cent,  concentrations.  Spirits  are  here  more 
deleterious  than  can  be  explained  by  their  alcohol,  while 
the  acid  reactions  of  wines  and  beers  are  unfavourable  to 
the  digestion. 

In  practice  it  is  probable  that  alcohol  reaches  the  intes- 
tine in  such  comparatively  small  quantities  and  such  dilute 
solution,  while  it  is  also  so  quickly  absorbed  there,  that 
its  action  on  pancreatic  digestion  is  of  small  importance. 
To  sum  up  these  results,  wre  may  say  that  moderate 
quantities  of  alcohol,  particularly  when  mixed  with  other 
foods,  have  no  serious  effect,  good  or  bad,  upon  the 
chemical  processes  of  gastric  or  pancreatic  digestion,  and 
this  is  true  both  of  persons  who  are  moderate  users  of 
alcohol  and  of  total  abstainers. 

Psychic  effect  of  alcohol  in  relation  to  digestion. 

It  has  been  suggested  that  the  action  of  alcohol  upon 
the  central  nervous  system,  the  brain  and  spinal  cord, 
may  help  digestion  by  distracting  the  subject's  attention 


6[ 

from  worries  and  promoting  a  more  cheerful  outlook 
upon  life,  because  of  the  interaction  of  the  nervous  system 
with  other  organs  of  the  body.  Whether  this  is  or  is  not 
the  case  cannot  be  determined  by  laboratory  experiment. 
It  is  a  matter  of  common  knowledge  that  many  people 
eat,  they  say,  with  more  appetite,  if  alcohol  is  drunk 
with  or  before  the  meal,  but  there  is  no  reason  to  think 
that  the  actual  transformation  of  food  into  substances  fit 
to  be  absorbed  is  increased,  although  one  may  derive 
more  pleasure  from  a  meal  at  which  alcohol  is  taken. 
Alcohol  and  the  absorption  of  food. 

With  respect  to  absorption  itself,  that  is  the  passage  of 
the  digested  food-stuffs  into  the  blood,  while  there  is 
no  doubt  that  some  drugs,  for  instance  chloral  and 
strychnine,  are  readily  absorbed  when  given  in  alcohol, 
more  so  than  when  taken  in  wTater,  and  there  is  some 
reason  to  think  that  small  quantities  of  alcohol  in 
the  intestine  promote  the  absorption  of  food-stuffs,  there 
is  no  reliable  evidence  leading  to  the  conclusion  that 
moderate  doses  have  any  serious  effect,  one  way  or  the 
other,  upon  the  process  of  absorption  of  food. 

The  possibility  that  alcohol  may  promote  the  absorption 
of  harmful  bodies  which  would  not  otherwise  make  their 
way  into  the  blood,  is  considered  elsewhere.1 

Excessive  doses  of  alcohol  are  liable  to  cause  vomiting, 
partly  through  local  irritant  action  in  the  stomach  but 
mainly  indirectly  through  disturbances  in  the  nervous 
mechanisms. 

The  whole  subject  of  this  section  can  be  epitomised  in 
the  following  terms. 

Conclusions. 

Moderate  doses  have  never  been  shown  to  affect  appre- 
ciably the  digestive  organs  apart  from  their  taste  and 
their  tendency  to  increase  the  secretion  of  fluid  and 
mucus  from  the  walls  of  the  stomach. 

See  p.  95. 


62 

On  the  other  hand,  there  is  a  consensus  of  opinion 
that  some  of  the  alcoholic  beverages  may  be  more 
deleterious  than  others ;  wines  which  do  not  notice- 
ably interfere  with  the  digestion  of  one  man  may 
cause  trouble  to  another.1  The  alcohol  present  in  these 
wines  cannot  be  regarded  as  responsible,  for  the 
effects  are  not  observed  when  the  same  quantity 
and  concentration  of  alcohol  is  taken  in  another  form. 
The  solid  non-volatile  bodies  in  the  wines  have  usually 
been  blamed  for  the  dyspepsia  sometimes  associated  with 
the  use  of  them,  and  possibly  with  justice.  But  it  is 
not  possible  to  dismiss  the  volatile  bouquet  substances 
from  consideration,  as  similar  differences  are  observed  in 
the  use  of  different  forms  of  spirits  where  the  non- 
volatile substances  are  present  in  but  very  small  quantities 
and  appear  to  be  harmless.  In  these  spirits,  the  higher 
alcohols  (fusel  oil)  and  the  ethers  are  popularly  credited 
with  the  action  on  the  stomach,  and  there  is  some  ground 
for  believing  them  more  disturbing  to  the  digestion  than 
pure  alcohol.  The  changes  induced  by  these  bodies  are, 
howrever,  quite  unknown,  and  may  be  different  in  character 
from  those  due  to  alcohol  itself. 


1  Roberts.  Collected  Contributions  on  Digestion  and  Diet, 
1891.  Chittenden,  in  Physiological  Aspects  of  Liquor  Problem, 
Vol.  I,  1903. 


63 


CHAPTER  VI. 

Action   of   Alcohol  on   the    Respiration    and   ox 
the  Circulation  of  the  Blood. 

This  chapter  is  concerned  with  some  of  the  minor  effects 
which  follow  the  use  of  alcohol  in  moderate  doses :  effects 
so  small  that  they  are  easily  overlooked  altogether,  and 
have  no  real  importance  in  the  ordinary  use  of  alcohol 
by  normal  persons. 

In  the  literature  devoted  to  the  action  of  alcohol  these 
effects  have  received  an  amount  of  attention  which  seems 
out  of  proportion  to  their  real  significance.1  There  are 
two  reasons  for  the  importance  which  has  been  attributed 
to  them. 

In  the  first  place  it  must  be  realised  that  a  large  part  of 
the  reputation  which  alcohol  has  enjoyed  as  a  medicine, 
is  attributable  to  the  belief  that  it  stimulates  a  feeble 
heart  or  failing  respiration.  With  medical  men,  until 
comparatively  recent  years,  alcohol  was  the  favourite 
"respiratory  and  cardiac  stimulant,"  and,  indeed,  practi- 
cally the  only  one  available.  It  is  still  the  most  popular 
domestic  remedy  for  the  temporary  failure  of  the  heart,  and 
secondarily  of  the  respiration,  which  is  known  as  "  faint- 
ing." It  is  clearly  of  importance,  therefore,  to  know 
whether  alcohol  really  possesses  the  stimulating  action  on 
these  vital  functions,  with  which  it  has  been  generally 
credited. 

A  second  reason  for  the  amount  of  investigation  which 
has  been  devoted  to  these  effects,  is  that  the  discussion  of 
their  nature  formed  part  of  a  wider  controversy,  concern- 
ing  the   action    of   alcohol    on   the   body  generally,  and 

1  For  a  general  review  of  the  literature,  except  for  recent  }-ears, 
see  Abel,  in  "  Physiological  Aspects  of  the  Liquor  Problem," 
Vol.  II,  Boston,  1903. 


64 

especially  on  the  brain  and  nervous  system.  In  the 
chapter  dealing  with  the  mental  action,  we  have 
seen  that  one  school  of  opinion  has  maintained  that 
moderate  doses  of  alcohol  have  a  truly  stimulant  action, 
while  another  school  has  regarded  the  appearance  of 
increased  mental  activity  as  misleading,  and  has  supported 
the  view  that  alcohol,  even  in  the  smallest  dose  having 
any  perceptible  effect,  is  always  depressant  or  paralysing  in 
its  action.  The  effects  on  the  respiration  and  the  pulse 
are  such  as  can  easify  be  measured  and  recorded,  and  the 
partisans  of  the  one  theory  were  accordingly  eager  to 
demonstrate  that  alcohol  had  a  genuine  stimulant  action 
in  these  cases,  however  small  it  might  be ;  while  their 
opponents  showed  a  corresponding  anxiety  to  "prove  that 
any~  appearance  of  such  a  stimulant  action  could  be 
explained  in  other  ways. 

Sub-Chapter  I. 
The  Action  of  Alcohol  on  Respiration. 

Normal  iv  or  king  of  respiratory  mechanism. 

The  movements  of  respiration,  by  which  air  is  rhythmi- 
cally drawn  into  and  expelled  from  the  lungs,  show  wide 
variations  both  of  depth  and  rhythm,  even  under  normal 
conditions  of  active  life.  These  movements  are  initiated 
by  the  activity  of  a  nervous  centre, .  called  the  "respira- 
tory centre,"  which  is  situated  in  the  hindmost  part  of 
the  brain,  just  above  the  level  where  it  becomes  continuous 
with  the  spinal  cord.  The  activity  of  the  centre  is  nor- 
mally called  forth  by  the  presence  of  carbon  dioxide  in  the 
blood  carried  to  it  by  the  circulation.  If  the  blood  is 
deprived  of  carbon  dioxide  completely,  the  breathing 
stops  altogether.  If  the  quantity  of  carbon  dioxide  in  the 
blood  becomes  abnormally  great,  the  respiration  becomes 
rapid  and  laboured  ;  as  when  we  find   ourselves   "out  of 


65 

breath  "  after  running  up  a  flight  of  stairs.  The  action 
of  the  centre  is  also  modified  by  the  activity  of  other  parts 
of  the  brain  and  nervous  system.  The  respiration  is  to 
a  large  extent  controllable  by  the  will,  and  is  affected  by 
every  emotion  ;  we  "  gasp  with  astonishment,"  "  hold  the 
breath  with  anxiety,"  or  "  pant  with  eagerness."  It  is 
also  subject  to  "reflex"  effects  from  the  stimulation  of 
sensory  nerves  ;  a  sudden  pain,  a  dash  of  cold  water  on 
the  skin,  makes  us  gasp  or  pant  for  breath. 

Indirect  effects  of  alcohol  on  respiratory  activity. 

Since  the  rhythm  of  breathing  is  normally  subject 
to  such  wide  variations,  it  is  clear  that  a  small  effect 
of  a  drug  will  be  difficult  to  detect  with  certainty, 
unless  special  precautions  are  taken.  Under  ordinary 
conditions  a  dose  of  alcohol  will  produce,  in  many 
persons,  a  condition  of  excitement,  talkativeness,  and 
restless  muscular  activity.  The  fact  that  this- is  accom- 
panied by  quicker  and  deeper  breathing  cannot  be  taken 
to  represent  an  action  of  alcohol  on  respiration ;  for  a 
similar  access  of  respiratory  activity  can  be  seen  in 
persons  of  excitable  temperament  if,  without  having 
taken  alcohol,  the}7  become  engaged  in  animated  discus- 
sion and  gesticulate  freely. 

Earlier  observations  :  difficulties  in  their  interpretation. 

Many  competent  observers  formerly  stated,  however, 
that  the  taking  of  a  moderate  dose  of  alcohol,  by  a  subject 
kept  in  repose  and  carefully  protected  from  disturbing 
influences,  was  followed  by  a  small  but  definite  increase 
of  respiratory  activity.  All  forms  of  increase  in  activity 
were  recorded  :  a  quicker  rate,  with  deeper,  unaltered, 
or  shallower  individual  respirations,  or  even  a  deepening 
of  each  breath  without  alteration  of  the  rate.  The  nett 
result  was,  however,  in  general  an  increase  in  the 
volume  of  air  breathed  in  a  given   time.     One  observer 


66 

stated  that  the  effect  was  more  pronounced  with  a  wine 
of  fine  bouquet  than  with  pure  alcohol,  and  noted  its 
special  prominence  in  subjects  suffering  from  fatigue. 
A  long  and  vigorous  discussion  arose  as  to  the  nature 
of  this  effect.  It  would  be  unprofitable  to  follow  this 
into  all  its  detail,  and  it  will  suffice  to  indicate  the 
main  lines  of  the  argument.  Those  who  believed  that 
alcohol  never  stimulates  the  brain,  and  who  were  there- 
fore unwilling  to  admit  that  it  would  stimulate  the 
respiratory  centre,  attributed  the  effect  to  an  -  irritant 
action  on  the  mucous  membrane  of  the  stomach.  The 
similar  effects  seen  in  experiments  on  animals,  when  the 
alcohol  was  inhaled  as  vapour,  or  injected  under  the 
skin,  were  similarly  attributed  to  irritation  of  the 
lining  of  the  wind-pipe  and  the  lungs,  or  the  nerves  in 
the  subcutaneous  tissue.  Other  irritant  substances,  such 
as  mustard,  were  said  to  cause  a  similar  increase  of 
respiratory  movement,  when  they  were  introduced  into 
the  stomach.1 

On  the  other  hand,  the  adherents  of  the  "  stimulant " 
theory  of  the  action  of  alcohol,  claimed  the  effect  on 
respiration  as  supporting  their  view.  They  pointed 
out  that  the  effect  was  apparently  not  diminished  by 
diluting  the  alcohol  freely  with  water  before  it  was 
swallowed;  whereas  the  irritant  action  of  strong  spirit 
would  be  greatly  reduced  by  such  dilution.2  They 
laid  much  stress  also  on  the  fact  that  the  injection 
of  suitably  diluted  alcohol  directly  into  the  vein  of  an 
animal  was  followed  by  an  increase  of  respiratory 
activity ;  and  under  such  conditions,  there  was  no 
possibility  of  local  irritative  action,  affecting  the 
respiratory  centre  indirectly.3 

1  Jaquet— Archives  Internationales  de  Pharmacodynamic,  Vol.  2, 

p.  107.     1896. 
-  Wilmanns— Pfliiger's    Archiv.    fiir    die    gesammte    Physiologic, 

Vol.  66,  p.  167.     1897. 
3  Binz — Centralblatt  fiir  innere  Medizin,  p.  1.     1891. 


67 

Experiments  to  test  the  effect  of  alcohol  on  the  excitability 
of  the  respiratory  centre. 

In  the  light  of  more  modern  information,  concern- 
ing the  normal  activity  of  the  respiratory  centre,  and 
the  manner  of  its  control,  much  of  this  discussion 
seems  irrelevant.  We  have  seen  that  the  respiratory 
centre  does  not  work  automatically,  but  only  in 
response  to  the  stimulating  action  of  carbon  dioxide  in 
the  blood.  When  it  is  suggested,  therefore,  that  a 
drug  like  alcohol  has  a  "  stimulant "  action  on  the 
respiratory  centre,  this  can  only  mean  that  it  makes 
the  centre  more  readily  responsive  to  carbon  dioxide. 
The  excitability  of  the  centre  can  be  tested,  by 
measuring  the  effect  produced  on  the  breathing,  when 
a  definite  proportion  of  carbon  dioxide  is  added  to  the 
air  which  is  breathed.  Such  a  measurement,  before  and 
after  a  dose  of  alcohol,  was  indeed  made  many  years  ago.1 

Two  subjects  were  chosen  for  the  experiments,  one 
accustomed  to  taking  alcohol,  the  other  not.  Each  was 
given,  on  separate  occasions,  a  dose  of  35  cubic  centi- 
metres and  another  of  60  cubic  centimetres  of  alcohol. 
The  quantities  of  whisky  at  proof  containing  these 
amounts  of  alcohol  would  be  2  J  ounces  and  rather  less 
than  \\  ounces  respectively.  Only  in  one  case  was  an 
increase  in  the  excitability  of  the  respiratory  centre 
detected,  namely,  when  the  larger  dose  was  given  to  the 
person  who  was  not  used  to  taking  alcohol. 

Proportion  of  carbon  dioxide  in  tl  alveolar  air"  as  a  measure 
of  the  excitability  of  the  respiratory  centre. 

Another  method  of  measuring  the  excitability  of  the 
respiratory  centre  has  been  used  in  more  recent  experi- 
ments. The  activity  of  the  centre  so  adjusts  itself  to 
the  need  of  the  body  to  get  rid  of  carbon  dioxide, 
that   the   proportion    of    carbon    dioxide   in    the    blood 

1  Loewy — Pfluger's  Archiv,  fur  die  gesammte  Physiologie,  Vol.  47 
p.  601.     1890. 

16392  7 


68 

filling  the  arteries  is  kept  practically  constant.  The 
gases  held  by  this  blood  are  in  equilibrium  with  the 
air  in  the  deepest  recesses  of  the  lungs — the  so-called 
"  alveolar  air."  Samples  of  this  air  can  easily  be 
obtained  and  analysed,  and  it  has  been  found  that  the 
proportion  of  carbon  dioxide  in  it  remains  very  constant 
in  the  same,  individual  under  similar  conditions.  When 
the  rate  at  which  carbon  dioxide  is  being  formed  in  the 
body*  increases,  the  respiratory  centre  is  stirred  to 
greater  activity,  and  the  more  active  breathing  quickly 
readjusts  the  proportion  of  carbon  dioxide  in  the  alveolar 
air  to  its  normal  level. 

Now  it  will  be  clear  that,  if  the  normally  constant  pro- 
portion of  carbon  dioxide  undergoes  a  change  and  takes 
up  a  new  level,  this  must  indicate  a  change  in  the  excita- 
bility of  the  respiratory  centre.  If  more  carbon  dioxide 
accumulates  in  the  air  in  the  lungs,  we  know  that  the 
excitability  of  the  centre  has  become  less ;  for  otherwise 
the  tendency  to  such  accumulation  would  have  excited 
the  centre  to  greater  activity,  and  the  more  vigorous 
breathing  would  have  swept  carbon  dioxide- out  of  the 
lungs  more  rapidly,  so  as  to  maintain  the  normal  propor- 
tion. If,  on  the  contrary,  the  proportion  of  carbon 
dioxide  in  the  alveolar  air  becomes  less,  we  know  that 
this  indicates  an  increase  in  the  excitability  of  the  centre; 
for  otherwise  the  tendency  to  diminution  of  the  amount 
of  carbon  dioxide  would  have  resulted  in  smaller  activity 
of  the  centre,  and  the  slower  and  shallower  breathing 
would  have  allowed  the  normal  proportion  of  carbon 
dioxide  to  remain.  More  active  breathing  may,  there- 
fore, be  brought  about  either  by  an  increase  in  the 
excitability  of  the  respiratory  centre  to  the  normal  pro- 
portion of  carbon  dioxide,  or  by  a  more  rapid  production 
of  carbon  dioxide  by  the  bod)'.  In  the  former  case,  a 
decrease  in  the  proportion  of  carbon  dioxide  in  the 
alveolar  air  would  be  detected,  in  the  latter  it  would  not 


69 

change  perceptibly.  The  two  influences  may  work  in 
opposition — e.g.,  an  increase  in  the  excitability  of  the 
centre  may  be  accompanied  by  diminished  production  of 
carbon  dioxide ;  and  in  such  a  case  there  may  be  no 
change,  or  even  a  decrease  of  respiratory  activity,  although 
the  excitability  of  the  centre  has^  risen. 

Experiments  to  determine  the  effect  of  alcohol  on  the  proportion 
of  carbon  dioxide  in  the  "alveolar  air" 

It  will  be  clear  that  the  interpretation  of  an  apparent 
effect  of  alcohol  on  breathing  is  a  much  more  complicated 
matter  than  the  earlier  investigators  supposed.  Quite 
recently  the  changes  in  all  the  different  factors  have 
been  carefully  investigated  in  a  series  of  men.1  Seven 
subjects  were  chosen  for  the  experiments,  whose  ex- 
perience of  alcohol  included  all  variations  from  habitual 
abstinence  to  daily  use.  In  each  test  two  doses  were 
used,  30  cubic  centimetres  and  45  cubic  centimetres  of 
pure  alcohol,  suitably  diluted  with  a  flavouring  mixture ; 
the  equivalents  in  alcohol  of  whisky  at  proof  would  be 
rather  more  than  2  ounces  and  3  ounces  respectively. 
The  doses  were  large  enough  to  produce  distinct 
physiological  effects — feelings  of  comfortable  warmth  and 
drowsiness,  and  in  some  cases  talkativeness  and  mental 
excitement ;  on  the  other  hand,  they  were  not  enough  to 
cause  definite  inebriation.  The  patients  were  kept  care- 
fully at  rest,  and  under  constant  observation,  and  each 
alcohol  experiment  was  controlled  by  one  in  which  the  sub- 
ject took  the  same  flavouring  mixture  without  the  alcohol. 

In  a  certain  proportion  of  the  experiments  there  was  an 
indication  of  a  slight  increase  in  the  excitability  of  the 
respiratory  centre,  the  proportion  of  carbon  dioxide  in 
the  alveolar  air  undergoing  a  small  reduction  after 
alcohol  had  been  taken.  This  effect,  however,  was 
counterbalanced  by  a  diminished  production  of  carbon 

1  Higgins — Journal  of  Pharmacology  and  Experimental  Thera- 
peutics, Vol.  9,  p.  441.     1917- 


7° 

dioxide  by  the  body.  The  nett  result  on  the  breathing 
was  that  the  volume  of  air  breathed  per  minute  was 
either  unchanged  or  slightly  diminished. 

Conclusions  regarding  the  action  of  alcohol  on  respiration. 

There  need  be  no  hesitation  in  accepting  these  experi- 
ments, made  by  the  most  recent  methods,  as  giving  a 
true  account  of  the  action,  or  want  of  action  of  alcohol 
itself  on  the  respiration.  The  fact  that  a  definite,  though 
small  increase,  in  the  volume  of  air  breathed,  was  so 
consistently  observed  by  the  earlier  workers  to  follow  the 
taking  of  alcohol,  may  be  explained  in  one  of  two  ways. 
Either  (i)  their  precautions  against  an  increase  of 
muscular  activity  following  the  taking  of  alcohol  were 
imperfect,  so  that  the  effect  they  observed  was  in  part  the 
indirect  result  of  more  rapid  formation  of  carbon  dioxide ; 
or  (2)  the  wines,  brandy,  etc.,  used  in  some  of  the  earlier 
experiments  contained,  among  their  ethereal  bouquet- 
substances,  some  which  had  more  action  on  the  respira- 
tory centre  than  alcohol.  Only  further  experiment,  by 
modern  methods,  could  decide  between  these  possibilities. 
For  our  present  purpose  it  is  sufficient  to  have  reached 
the  conclusion  that  alcohol,  in  moderate  doses,  has  no 
effect  on  the  respiration  of  practical  importance,  eithei 
for  its  use  by  normal  persons,  or  for  its  medicinal  use 
The  only  important  effect  of  alcohol  011  respiration  is  the 
paralysis  of  the  respiratory  centre  by  large  doses,  which,  as 
another  chapter  shows,1  is  the  cause  of  death  in  poisoning.2 

1  Chapter  VIII,  p.  86. 

-  Since  this  section  was  sent  to  the  printers  an  interesting  note 
has  been  published  by  Hooker  (J ourn.  of  Pharmacology  and  Exp. 
Therapeutics,  vol.  X.,  1917,  p.  121),  who,  by  an  ingenious  method 
of  artificial  perfusion,  has  tested  the  direct  action  of  alcohol  on 
the  respiratory  centre,  isolated  from  the  general  circulation.  Hi 
results  confirm  the  stimulant  action  of  low  concentrations  of 
alcohol  on  the  centre ;  but  the  conditions  are  so  abnormal,  that 
no  deduction  can  be  made  as  to  the  importance  of  the  action 
under  normal  conditions,  and  no  revision  seems  necessary  of  our 
conclusions  as  to  the  trivial  nature  of  the  effect  on. respiration  of 
alcohol  as  taken  by  man. 


7i 

Sub-Chapter  II. 

Action  of  Alcohol  in  the  Circulation  of  the  Blood. 

In  ivhat  ways  a  drug  may  influence  the  Circulation. 

A  drug  can  influence  the  circulation  of  the  blood  by 
causing  either  a  change  in  the  rate  or  strength  of  the 
heart's  beating,  or  a  change  in  the  state  of  contraction  of 
the  blood-vessels,  especially  of  the  smaller  arteries.  The 
heart  is  a  muscular  pump,  which  at  each  beat  drives  a 
spurt  of  blood  into  the  great  arteries,  causing  a  wave  of 
pressure,  the  pulse-wave,  to  travel  down  them.  Where 
the  large  arteries  divide  into  small  ones,  and  these  again 
open  into  the  net-work  of  capillary  blood-vessels,  the  flow 
of  blood  encounters  a  pronounced  resistance.  As  a  result 
of  this  resistance,  and  of  the  elasticity  of  the  larger 
arteries,  a  head  of  pressure  is  built  up  in  these,  by  which 
the  blood  is  driven  on  through  the  capillaries  into  the 
veins  in  a  steady  stream.  The  maintenance  of  this 
"arterial  blood-pressure,"  which  is  one  of  the  essential 
factors  of  an  efficient  circulation,  depends  on  the  rate  and 
volume  of  the  heart-beat,  and  on  the  state  of  contraction 
of  the  small  arteries.  The  arterial  pressure  rises  when  the 
heart-beats  follow  one  another  more  rapidly,  or  when  the 
volume  of  blood  expelled  at  each  beat  increases ;  and  it 
rises  also  when  the  walls  of  the  small  arteries  contract, 
and  increase  the  resistance  to  the  flow  of  blood  out  of  the 
arteries.  If  the  heart-beat  becomes  slower  or  weaker, 
or  if  a  general  relaxation  of  the  small  arteries  occurs,  the 
arterial  blood-pressure  falls.  But  the  arteries  of  the 
whole  body  need  not,  and  do  not  usually  contract  or  relax 
together.  The  arteries  in  the  skin,  for  example,  may 
contract,  while  those  of  internal  organs  relax ;  and  the 
result  may  be  that,  while  the  pressure  in  the  large  arteries 
is  unchanged,  a  larger  proportion  of  the  blood  goes  to 
the  internal  organs,  and  less  to  the  skin  than  before. 


72 

In  discussing  the  effect  of  alcohol  on  the  circulation  of 
the  blood,  the  main  points  on  which  information  are 
required  are,  therefore,  its  effect  on  the  rate  and  strength 
of  the  heart-beat  or  the  pulse,  and  its  effect  on  the  state 
of  contraction  of  the  smaller  arteries ;  and  we  further 
have  to  inquire  whether,  as  the  result  of  the  effects  on 
the  heart  and  arteries,  any  change  occurs  in  the  pressure 
of  the  blood  in  the  larger  arteries. 

Effect  of  alcohol  on  the  superficial  blood-vessels. 

There  are  only  two  features  of  the  action  of  moderate 
doses  of  alcohol  on  the  circulation  concerning  which  there 
is  anything  like  a  general  agreement.  All  who  have  studied 
the  matter  are  agreed  as  to  the  general  relaxation  of  the 
small  arteries  carrying  blood  to  the  skin.  This  causes  a 
slight  general  flushing  of  the  surface  and  accounts  for 
the  comfortable  feeling  of  bodily  warmth  which  the  taking 
of  alcohol  produces.  It  is  more  important  for  its  effect 
on  the  body  temperature,  which  is  dealt  with  in  the 
following  chapter,  than  for  its  effect  on  the  general 
circulation  of  the  blood.  But  it  will  be  clear,  from  what 
has  been  said  above,  that  such  a  dilatation  of  the  skin 
vessels  will  be  attended  by  some  fall  of  the  arterial  blood- 
pressure,  unless  it  is  compensated  either  by  a  constriction 
of  arteries  carrying  blood  to  internal  organs,  or  by  an 
increase  in  the  activity  of  the  heart. 

Effect  of  alcohol  on  the  pulse-vale. 

The  majority  of  observers  are  further  agreed  in  stating 
that  the  swallowing  of  a  moderate  dose  of  alcohol  is 
followed  by  an  increase  in  the  rapidity  of  the  heart-beat, 
which  lasts  for  about  half  an  hour.  There  are  some  who 
have  failed  to  detect  this  action,  and  others  even  who 
observed  that  the  pulse  became  slower  after  alcohol  was 
taken.  The  rate  of  the  pulse  is  not  a  matter  concerning 
which  there  can  be  a  difference  of  opinion,  and  it  can  only 


73 

be  concluded  that  different  subjects  react  differently  to 
alcohol  in  this  respect,  while  dose  and  dilution  have 
probably  some  influence  on  the  effect.  There  seems  to  be 
no  doubt  that  a  slight  quickening  of  the  pulse  commonly 
occurs.  In  the  most  recent  series  of  experiments  on  the 
effect  of  alcohol  on  respiration,  described  in  the  foregoing 
section,  records  of  the  pulse-rate  were  taken.  These 
showed  a  small  acceleration,  following  the  taking  of 
alcohol,  in  about  half  the  experiments.  In  the  others  no 
change  was  detected.1 

Quickening  of  the  pulse  under  alcohol  is  probably  brought 

about  indirectly. 

There  is  very  good  reason,  however,  for  believing  that 
this  effect,  weak  and  inconstant  as  it  is,  is  not  due  to  a 
direct  action  of  alcohol  on  the  heart.  It  has  been 
seen  to  occur  wThen  alcohol  of  sufficient  concentration 
(50  per  cent.)  was  simply  taken  into  the  mouth  and 
rejected  without  being  swallowed.  In  this  case,  the 
quickening  of  the  pulse  only  lasted  for  a  few7  minutes, 
whereas,  if  the  dose  was  swallowed,  the  quickening  lasted 
for  half  an  hour  or  so.2  It  seems  reasonable  to  attribute 
at  least  a  part  of  the  result  to  the  continuance  in  the 
stomach  of  the  irritating  action  of  alcohol  on  mucous 
membranes,  which  must  be  the  immediate  cause  of  the 
effect  seen  when  alcohol  is  held  in  the  mouth. 

The  heart-beat,  though  automatic,  is  under  the  constant 
controlling  influence  of  the  nervous  system.  Under 
normal  conditions,  the  heart  is  held  in  check  by  impulses 
from  an  "inhibitory  centre,"  so  that  the  rate  is  less  than 
that  at  which  the  heart  would  beat  if  freed  from  such 
control.  This  restraint  can  be  weakened  by  various 
causes.  The  quickening  of  the  heart  in  response  to  the 
irritation  of  mucous  membranes  by  alcohol  is  probably  an 

1  Higgins — loc.  cit. 

2  Dixon — Journal  of  Physiology,  Vol.  35,  p.  346.     1907. 


74 

example  of  a  reflex  weakening  of  this  control.  A  quick- 
ening of  the  heart,  largely  due  to  a  similar  action, 
regularly  accompanies  muscular  activity;  and  it  is  not 
unlikely  that  the  tendency  to  restless  movement,  which 
follows  the  taking  of  alcohol,  also  plays  its  part  as  an 
indirect  cause  of  the  quickened  pulse.  That  the  effect  is, 
in  the  main,  an  indirect  one,  has  been  shown  by  experi- 
ments, conducted  by  a  number  of  observers,  on  the  action 
of  alcohol  on  the  heart  isolated  from  the  bod3^. 

Experiment  to    test   the    action    of  alcohol   on    the    isolated 

heart. 

The  heart  of  a  recently  killed  animal,  if  blood  or  a  suit- 
able nutritive  fluid  is  made  to  flow  through  its  blood- 
vessels, can  be  kept  beating  for  hours  or  days  outside 
the  body.  Under  such  conditions  its  action  is  uncom- 
plicated by  changes  in  the  rest  of  the  circulatory 
system,  and  is  free  from  all  nervous  control.  Alcohol 
in  accurate^  measured  proportion  can  be  added  to  the 
fluid  perfusing  the  heart,  and  the  direct  and  uncom- 
plicated effect  of  such  addition  on  the  beat  of  the 
heart  can  thus  be  studied. 

Most  of  those  who  have  made  such  experiments  have 
failed  to  detect  any  quickening  or  strengthening  of  the 
heart-beat  under  the  influence  of  alcohol  of  any  con- 
centration.1 Such  observers  found  that,  in  concentrations 
up  to  about  o*i  per  cent.,  alcohol  was  without  effect. 
Others  have  observed  some  strengthening  of  the  beat 
as  the  result  of  such  low  concentrations  of  alcohol.2 
This,  however,  appears  to  have  been  due  to  the  fact 
that  the  heart,  during  the  long  perfusion,  had  used  up 
much  of  its  reserve  supply  of  food-material,  needed 
for   producing  the   energy   of   its  beat,  and  that,  under 

1  S<  e  Backman — Skandinavisches  Archiv  fiir  Physiologie,  Vol.  18 
(1906),  p.  323,  who  gives  full  references  to  earlier  work  on  these 
lines. 

2  Dixon — loc.  cit. 


75 

such  conditions,  it  was  able  to  use  alcohol  as  a  fuel, 
just  as  it  can  use  glucose  (grape-sugar)  added  to  the 
perfusion  fluid.  So  that  there  was  no  evidence  that 
alcohol,  in  these  concentrations,  had  a  specific  stimu- 
lating action  on  the  activity  of  the  heart;  on  the 
other  hand,  it  was  harmless. 

Direct  effect  on  the  heart  only  observed  with  large  doses, 
and  then  of  depressant  character. 
All  are  agreed  that  in  greater  concentrations  alcohol 
is  directly  harmful  to  the  heart.  The  investigators 
differ  as  to  the  concentrations  at  which  the  harmful  effect 
begins  to  be  manifest.  Those  who  used  a  pure  saline 
fluid  for  perfusion  through  the  vessels  of  the  heart 
observed  a  depressant  action  as  soon  as  the  proportion 
of  alcohol  rose  above  o*i  per  cent.  On  the  other  hand, 
in  experiments  in  which  blood  was  perfused,  even  "5 
per  cent,  of  alcohol  was  found  by  one  observer  to  have 
no  definitely  harmful  action.1  It  will  be  seen  later 
(Chapter  VIII)  that  when,  in  man,  the  concentration 
of  alcohol  in  the  circulating  blood  rises  above  o'i  per 
cent.,  the  condition  of  the  subject  becomes  one  of  definite 
inebriation,  while  at  a  concentration  of  0*5  per  cent.,  we 
are  approaching  the  fatal  limit.  There  seems  no  good 
reason,  therefore,  for  ascribing  to  direct  stimulation  of 
the  heart  any  favourable  effect  which  a  small  dose  of 
alcohol  may  appear  to  produce,  or  to  direct  depression 
of  the  heart,  a  large  share  in  the  danger  to  life  produced 
by  poisonous  doses.  The  effect  in  either  case,  whether 
of  quickening  or  depression,  must  be  mainly  the  indirect 
result  of  the  other  actions  of  alcohol. 

Effect  of  alcohol  on  arterial  blood-pressure. 

The  effects  of  alcohol  on   the   arterial  blood-pressure 

are  similarly  small  and  indefinite.     Some  observers  have 

1  Loeb — Archiv    fur  experimentelle  Pathologie  und  Pharma- 
kologie,  Vol.  52,  p.  451.     1906. 


76 

described  a  relatively  small  rise  of  the  arterial  pressure, 
as  the  result  of  injecting  small  doses  of  alcohol  directly 
into  the  circulation.1  Others  have  failed  to  detect  any 
definite  effect,  or  have  observed  a  small  decline  of 
arterial  pressure ;  while  one  found  that  the  pressure 
fell  if  alcohol  was  injected  into  a  vein  or  under  the 
skin,  but  rose  to  a  small  extent,  for  a  few  minutes,  if 
the  same  dose  of  alcohol  was  swallowed.2 

Conclusions. 
The  action  of  alcohol  on  the  heart  and  circulation  has 
theoretical  interest  for  the  pharmacologist,  and  has 
accordingly  been  the  subject  of  much  investigation  and 
discussion.  But  no  scientific  ground  has  been  discovered 
for  any  claim  made  on  behalf  of  alcohol  to  practical 
value  as  a  direct  stimulant  of  the  heart  in  cases  of 
threatened  failure  of  the  beat.  When  it  appears  to  pro- 
mote recovery  from  fainting,  it  probably  acts  simply  by 
virtue  of  its  irritant  action  on  the  mucous  membrane  of 
the  mouth  and  throat.  The  fact  that  the  beneficial  effect 
appears  almost  immediately,  and  long  before  any  signi- 
ficant amount  of  alcohol  can  have  been  absorbed  and 
carried  to  the  heart,  is  evidence  for  this  local  and  indirect 
nature  of  the  action.  Its  use  in  these  circumstances  is, 
therefore,  comparable  with  that  of  smelling  salts,  or  the 
irritating  fumes  of  burnt  feathers,  traditionally  employed 
for  the  same  purpose.  When,  in  conditions  of  more  pro- 
tracted weakness  of  the  heart,  the  administration  of 
alcohol  has  a  beneficial  effect,  this  must  be  attributed 
mainly    to    its    mildly    narcotic    and     sedative     action, 

1  Dixon — Ivoc.  cit. 
Kochmann — Archives   Internal,   de   Pharmacodynn.     Vol.  13, 

p.  329.     1904. 
Bachem — Archives  Internat.  de  Phannacodyn.     Vol.  14,  p.  437. 

1905- 
Brooks — Journal  of  the  American  Medical  Association.    Vol.  30, 

p.  373.     1910. 


77 

relieving  the  centres,  which  modify  the  action  of  the 
heart,  from  the  disturbing  influence  of  pain  and  anxiety. 
The  promotion  of  a  patient's  comfort,  the  relief  of  mental 
strain,  may  be  an  essential  element  in  the  treatment  of 
disease,  and  an  important  factor  in  recovery.  It  does  not, 
however,  justify  the  description  of  alcohol  as  a  "  stimu- 
lant" of  the  heart.  In  this  direction,  as  in  others,  the 
popular  idea  that  it  is  a  "  stimulant  "  proves  on  examina- 
tion to  be  scientifically  untenable. 


78 


CHAPTER  VII. 

The  Influence  of  Aixohoi,  on  the  Body 

Temperature. 

Distinction  between  surface  temperature  and  deep  temperature. 

In  speaking  of  body  temperature  we  must  carefully 
distinguish  between  the  surface  temperature,  i.e.,  the 
temperature  of  the  surface  of  the  skin,  and  the  deep 
temperature,  which  is  that  of  the  underlying  parts  and 
the  internal  organs. 

The  surface  temperature  is  in  general  lower  than  the 
deep  temperature,  but  the  most  important  difference 
between  the  two  is  that,  whereas  the  surface  temperature 
varies  widely,  not  only  at  different  times  but  on  different 
areas  of  the  skin  at  the  same  time,  the  deep  temperature 
is,  in  health,  remarkably  constant.  If  one  hand  is  plunged 
into  hot  water  (at  45  degrees  Centigrade,  i.e.,  113  degrees 
Fahrenheit,  for  example)  and  the  other  into  melting 
snow,  the  surface  temperature  of  the  former  rises  higher 
than  the  deep  temperature,  while  that  of  the  latter  falls 
far  below  it.  If  the  temperature  on  the  surface  of  the 
body  be  taken  immediately  on  rising  from  bed  on  a 
winter's  morning,  and  again  immediately  after  a  cold 
bath,  it  will  be  found  to  have  fallen  through  a  long  range. 
Through  all  these  changes,  however,  the  deep  temperature 
will  have  remained  practically  unaltered,  as  may  be 
verified  by  taking  the  temperature  under  the  tongue, 
with  the  lips  closed,  before  and  after  the  cold  bath. 

This  maintenance  of  the  deep  temperature  at  a  practi- 
cally constant  level,  with  but  small  fluctuations  from  its 
normal  average  of  37  degrees  Centigrade1  (or  98*6  degrees 

1  Normally  the  temperature  curve  exhibits  a  regular  diurnal 
cycle,  reaching  a  maximum  between  4  p.m.  and  8  p.m.  and  a 
minimum  between  2  a.m.  and  6  a.m.  The  extreme  range  is 
between  1  and  2  degrees  Fahrenheit,  and  the  cycle  is  related  to 
variations  in  the  activitv  of  metabolism. 


79 

Fahrenheit)  is  an  essential  condition  of  health ;  for  it  is 
only  at  this  temperature  that  the  chemical  and  physical 
changes  of  the  living  tissues  proceed  at  their  normal  rate. 
This  constancy  of  the  deep  temperature  gives  to  the 
clinical  thermometer  its  value  as  an  instrument  for 
detecting  the  onset  of  illness,  and  for  measuring  its 
progress. 

How  the  deep  temperature  is  maintained  at  its  normal  level 

in  health. 

We  have  seen  that  the  chemical  changes  of  the  body, 
viewed  as  a  whole,  are  in  effect  a  combustion,  and  are 
accompanied  by  the  evolution  of  heat.  This  constant 
production  of  heat  renders  the  body  warmer  than  the  air 
and  most  of  its  surroundings.  Heat  is,  therefore,  always 
being  generated  in  the  body,  and  always  being  lost  at  its 
surface  to  the  air.  The  maintenance  of  the  deep 
temperature  at  its  normal  level  involves  a  continual 
adjustment  of  these  two  processes,  so  that  the  amount  of 
heat  lost  at  the  surface  just  balances  the  amount  that  is 
evolved  within.  The  rate  at  which  heat  is  produced  in 
the  body  is  always  varying,  with  changes  in  the  activity 
of  the  muscles  and  of  the  glandular  organs.  The  rate  at 
which  heat  is  lost  from  the  body  is  likewise  subject  to 
continual  variations,  with  changes  in  the  temperature 
and  moisture  of  the  air,  in  the  degree  to  which  the  skin 
is  exposed  to  it,  and  in  the  rate  at  which  winds  and 
currents  keep  the  cool  air  moving  over  the  surface  of  the 
body. 

The  heat-regulating  centre. 

The  adjustment  of  processes  by  wrhich  heat  is  produced 
and  lost  by  the  body  so  that  an  accurate  balance  is 
maintained,  is  under  the  control  of  a  nervous  centre  in 
the  brain,  the  unconscious  action  of  which  suffices  for 
moderate  changes  of  the  external  or  internal  conditions. 
We  may  confine  our  attention  to  the  manner  in  which  the 


8o 

body  protects  itself  against  a  fall  of  the  deep  temperature, 
since  this  is  of  the  greatest  importance  in  connection  with 
the  action  of  alcohol. 

Automatic  adjustment  of  body  temperature  in  exposure 

to  cold. 

When  the  body,  by  exposure  to  cold,  is  threatened  with 
a  loss  of  heat  at  a  rate  exceeding  that  of  its  production, 
the  first  means  of  readjustment  is  a  change  in  the 
distribution  of  the  circulating  blood  as  between  the  skin, 
where  heat  is  lost,  and  the  internal  organs,  where  it  is 
evolved.  The  nerves  of  the  skin,  excited  by  the  surface 
cooling,  call  into  action  the  nerve  centre  regulating  the 
body  temperature ;  this,  through  the  nerve-centre  which 
controls  the  contraction  of  the  small  arteries,  causes  a 
narrowing  of  the  channels  through  which  blood  is 
conveyed  to  the  skin.  L,ess  of  the  blood  streams  through 
the  cold  skin,  and  more  through  the  heat-producing- 
organs  in  the  interior.  The  result  is  a  further  fall  of 
temperature  of  the  skin ;  but  the  all -important  deep 
temperature  is  maintained.  If  the  exposure  to  cold  is 
more  severe  or  prolonged,  the  narrowing  of  the  blood 
vessels  in  the  skin  is  inadequate  to  protect  the  body 
against  excessive  loss  of  heat,  and  the  deep  temperature 
begins  to  fall.  This  fall  also  affects  the  heat-regulating 
centre,  through  which  the  heat-producing  organs,  such  as 
the  muscles,  are  stimulated  to  activity,  so  that  a  more 
rapid  evolution  of  heat  takes  place.  We  become 
conscious  of  the  uncontrollable  rhythmic  contraction  of 
the  muscles  and  call  it  "  shivering." 

How  conscious  effort  instinctively  assists  automatic 
mechanism. 

So  far  we  have  dealt  with  the  automatic,  involuntary 
mechanism  for  maintaining  the  deep  temperature  of  the 
body  at   a    constant   level.     In    the   normally  alert   and 


8i 

sensitive  person  this  automatic  regulation  is  assisted  by 
conscious  effort.  Before  the  stage  of  shivering  is  reached 
we  become  conscious  of  a  definite,  unpleasant  sensation, 
which  we  describe  as  "  feeling  cold."  This  is  due  to 
the  fall  in  the  temperature  of  the  skin,  accelerated,  as  we 
have  seen,  by  the  diversion  of  the  blood  to  the  interior  of 
the  body.  Of  a  fall  in  the  deep  temperature  we  are  not 
directly  conscious,  and  are  made  aware  of  it  only  through 
the  reaction  of  shivering.  The  feeling  of  discomfort  and 
misery  thus  engendered  is  a  natural  warning  of  impending 
injury  by  cold,  a  signal  that  the  deep  temperature  is 
beginning  to  fall,  and  that  the  balance  between  production 
and  loss  of  heat  can  no  longer  be  upheld  by  the 
unconscious  reflex  mechanism.  The  desire  to  reinforce 
the  automatic  adjustment  by  conscious  effort  becomes 
urgent.  We  find  ourselves  impelled  to  accelerate  the 
production  of  heat  by  vigorous  muscular  activity  and  to 
restrict  still  further  the  rate  of  its  loss  from  the  surface 
by  putting  on  more  clothes.  If  the  excessive  surface 
cooling,  which  is  the  cause  of  discomfort,  is  confined  to  a 
small  part,  such  as  a  hand,  we  may  endeavour  to 
alleviate  it  by  beating  and  chafing  the  part  affected,  and 
thus  restoring  in  it  a  freer  circulation  of  blood. 

Alcohol  causes  loss  of  heat  through  flushing  of  surface. 

Turning  now  to  the  action  of  alcohol,  it  will  be  re- 
membered that,  in  the  previous  chapter  (p.  72),  mention 
was  made  of  a  general  flushing  of  the  skin  surface,  a 
widening  of  the  small  arteries  carrying  blood  to  the  skin, 
as  one  of  its  effects  on  the  circulation  of  the  blood.  We 
saw,  indeed,  that  this  was  the  only  one  of  its  effects  on 
the  circulation  concerning  which  there  was  no  doubt  or 
difference  of  opinion. 

In  considering  the  bearing  of  this  effect  on  the  regulation 
of  the  body  temperature,  we  must  note,  in  the  first  place, 
that  such  flushing  of  the  skin  has,  as  a  necessary  result, 


82 

an  accelerated  loss  of  heat  from  the  surface  of  the  body. 
The  question  arises  whether  this  is  balanced  by  an 
increase  in  the  production  of  heat  by  the  internal  organs. 
There  is  no  evidence  to  indicate  that  alcohol  directly 
affects  the  rate  at  which  heat  is  formed  in  the  body. 
Indirectly,  indeed,  it  may  increase  the  rate  of  heat 
production,  by  weakening  the  control  of  the  brain,  and 
thereby  favouring  a  restless  muscular  activity.  In  a 
resting  subject  it  does  not  increase  the  production  of 
heat,  and  the  result  of  its  effect  on  the  circulation  through 
the  skin  is  a  fall  of  the  deep  temperature. 

Alcohol  blunts  the  warning  sensation  of  cold. 

So  far  as  the  unconscious  reaction  to  external  cold  is 
concerned,  therefore,  the  effect  of  alcohol  is  to  weaken 
the  action  of  the  heat-regulating  centre,  so  that  the 
protective  constriction  of  the  vessels  carrying  blood  to 
the  skin  is  relaxed.  What  of  the  conscious  instinctive 
reaction  ?  The  flushing  of  the  skin  relieves  the  un- 
pleasant sensation  of  "  feeling  cold,"  and  replaces  it  by  a 
comfortable  glow  of  warmth.  We  have  seen  that  under 
conditions  of  exposure  to  cold  the  unpleasant  sensation 
is  a  valuable  warning,  which  assists  the  maintenance  of 
the  deep  temperature  by  creating  an  impulse  towards 
muscular  exertion,  so  that  the  production  of  heat  is 
accelerated.  This  warning  sensation  alcohol  blunts  or 
annuls,  and  thereby  tends  to  preclude  the  instinctive 
protective  action,  which  the  warning  should  call  forth. 
It  impairs  or  annuls,  therefore,  the  conscious  instinctive 
reaction,  as  well  as  the  automatic,  reflex  mechanism  of 
adjustment.  From  the  point  of  view  of  maintaining  the 
deep  temperature,  the  influence  of  alcohol  is  evidently 
wholly  bad.  Its  popular  reputation  as  a  means  of 
"  warding-off  cold  "  is  due  to  the  relief  which  it  affords 
from  the  warning  discomfort. 


«3 

Practical  conclusions  regarding  use  of  alcohol  by  persons 
exposed  to  cold. 

If  the  practical  question  is  asked,  therefore,  whether  a 
person  who  feels  cold  can  take  alcohol  with  advantage,  the 
answer  must  depend  on  a  balance  between  discomfort  and 
danger.  Whereas  it  may  well  be  considered  legitimate  to 
incur  a  trivial  danger  in  order  to  avoid  a  considerable 
discomfort,  even  serious  discomfort  is  not  worthy  of 
consideration  if  the  alternative  is  danger  to  life  itself. 

It  may  be  safely  stated  that,  under  the  conditions  of 
ordinary  life  indoors,  or  in  the  open  when  the  tempera- 
ture of  the  air  is  mild,  the  effect  of  a  moderate  dose  of 
alcohol  on  the  body  temperature  has  no  importance.  In 
circumstances  of  brief  exposure  to  cold,  with  the  body  as 
a  whole  well  clad,  the  discomfort  due  to  a  chilling  of  the 
face  and  extremities  may  be  mitigated  by  the  use  of 
alcohol  without  likelihood  of  producing  a  dangerous  fall 
of  internal  temperature.  The  mental  depression  which 
accompanies  the  feeling  of  being  "  miserably  cold,"  the 
discomfort  of  numbed  hands,  can  be  alleviated  by  a  small 
dose  of  alcohol ;  and  the  relief,  though  short-lived,  reacts 
favourably  for  the  time  being  on  the  complexion  of  the  mind. 
The  cheerfulness  and  sense  of  energy,  which  thus  replace 
dejection  and  apathy,  will  not  improbably  awaken  a  desire 
for  muscular  activity ;  so  that  the  temporary  and,  in  itself, 
illusory  relief,  provided  by  alcohol,  may  pave  the  way  to 
the  more  genuine,  natural  and  permanent  remedy. 

Such  uses  of  alcohol,  for  the  relief  of  the  feeling  of  cold, 
are  suited  only  to  a  very  brief  emergency,  created  by 
exposure  to  a  degree  of  cold  which  is  merely  unpleasant. 
The  taking  of  alcohol  during,  or  as  a  preliminary  to,  pro- 
longed or  severe  exposure  to  cold,  is  on  every  ground  to 
be  condemned.  Any  sensation  of  warmth  which  it  pro- 
duces, under  such  conditions,  is  an  illusion  fraught  with 
danger ;  its  effect  is  to  render  the  subject  indifferent  to  a 
peril,  which  is  in  fact  seriously  increased  by  its  use. 

16392  g 


84 

When,  on  the  other  hand,  the  exposure  to  cold  is  at  an 
end,  and  the  victim  has  been  placed  under  conditions 
promoting  warmth,  the  use  of  alcohol  may  have  real 
value.  If,  for  example,  the  surface  of  the  body  has 
become  chilled  and  the  deep  temperature  has  been 
lowered  by  prolonged  immersion  in  cold  water,  when 
once  the  patient  has  been  wrapped  in  hot  blankets  and 
surrounded  with  hot  bottles,  the  administration  of 
alcohol  can  assist  the  restorative  measures  by  promoting 
the  return  of  blood  to  the  superficial  tissues,  to  which 
the  external  heat  is  applied. 


«5 


CHAPTER   VIII. 
Poison  Action  of  Alcohol. 
Drug  action  and  poison  action  differ  only  in  degree. 

In  the  case  of  alcohol,  as  in  the  case  of  other  drugs,  it  is 
impossible  to  draw  any  hard  and  fast  line  between  drug 
action  and  poison  action.  Drug  action,  when,  with 
increase  of  dose,  it  becomes  excessive,  passes  into  poison 
action ;  but  there  is  no  absolute  criterion  of  excess,  and 
an  action  which  under  one  set  of  circumstances  and  from 
one  point  of  view  may  be  regarded  as  excessive  and 
harmful,  may  under  other  circumstances  come  within 
the  denomination  of  a  drug  action.  For  instance,  a 
person  who  drinks  such  a  quantity  of  ether  that  he 
becomes  unconscious  would  certainly  be  considered  to 
be  suffering  from  poisoning,  and  yet  we  do  not  ordinarily 
speak  or  think  of  poisoning  in  the  case  of  a  patient  under 
an  anaesthetic,  though  his  condition  may  represent  a 
more  intense  and  dangerous  action  of  the  same  drug. 
In  reference  to  alcohol,  then,  it  will  be  sufficient  if, 
without  trying  to  be  too  precise,  we  take  it  that  a 
drinker  really  begins  to  suffer  from  acute  poisoning  as 
soon  as  he  shows  such  immediate  effects  of  the  drug  as 
interfere  with  his  normal  capacity  for  taking  care  of 
himself. 

The  symptoms  of  ordinary  drunkenness  have  been  fully 
described  in  Chapter  III,  where  it  was  pointed  out  that 
they  result  from  a  progressive  impairment  of  the 
functional  activity  of  the  nervous  centres  in  the  order 
from  the  highest  to  the  lowest,  that  is  to  say,  beginning 
with  the  centres  of  the  brain  that  have  to  do  with 
complex  mental  processes,  such  as  those  involved  in 
critical  judgment   and    self-control,    and    subsequently, 


86 

with  deepening  intoxication,  affecting  lower  levels  until 
finally  a  state  of  stupor  is  reached. 

In  this  final  stage  of  intoxication,  when  the  drinker,  in 
common  parlance,  is  "  dead  drunk  "  or  "  paralytic  drunk," 
the  nervous  centres  which  control  such  vital  activities 
as  the  movements  of  the  respiratory  muscles  are  more 
or  less  interfered  with,  as  shown,  for  instance,  by  the 
snoring  or  "  stertorous "  breathing  which  accompanies 
the  unconsciousness  of  drunkenness.  Ordinarily,  this 
condition  passes  gradually  into  a  state  of  deep  sleep, 
after  which  the  patient  returns  to  the  normal.  In  some 
cases,  however,  when  the  quantity  of  alcohol  taken  has 
been  very  large,  these  vital  centres  are  so  gravely 
affected  that  the  drunkard  may  die  from  failure  of 
respiration. 

Symptoms  due  altogether  to  action  on  central  nervous  system. 

All  the  symptoms  of  drunkenness,  then,  are  due 
essentially  to  the  acticn  of  alcohol  on  the  brain  and  the 
rest  of  the  nervous  svstem.  Even  when  i  kills  by  a: ate 
poisoning  it  kills  through  its  action  on  that  system,  and 
not  by  directly  injuring  any  other  bodily  organ.  This, 
indeed,  we  are  already  prepared  to  find,  for,  as  we  saw  when 
dealing  with  the  action  of  alcohol  on  the  other  functions 
of  the  body,  it  is  only  when  very  large  doses  of  the  drug 
are  taken  that  it  can  produce  an  immediate  effect  of  any 
significance  on  these  functions :  thus,  for  instance,  to 
depress  the  action  of  the  heart  to  an  appreciable  degree 
by  directly  influencing  that  organ,  we  saw  (Chapter  VI, 
p.  75)  that  alcohol  must  be  present  in  the  blood  in  a. 
proportion  of  about  "5  per  cent. — a  proportion  which 
would  imply  an  original  dose,  for  a  man  of  10  stone 
weight,  of  nearly  twelve  ounces  of  absolute  alcohol,  or 
well  over  a  pint  of  whisky  at  proof  strength.  With  such 
a  dose,  of  course,  in  an  ordinary  individual  the  direct 
effect  on  other  organs  would  be  negligible  in  presence  of 


37 

the  symptoms  of  profound  and  dangerous  intoxication 
of  the  central  nervous  system. 

Relation  of  symptoms  to  amount  of  alcohol  in  blooa. 
The  next  point  which  we  have  to  consider  is  how 
drunkenness  is  related  to  the  amount  of  alcohol  taken, 
and  to  the  particular  sort  or  sorts  of  alcoholic  beverage 
drunk.  We  shall  deal  first  with  the  question  of  dose. 
Alcohol  gets  to  the  central  nervous  system  by  passing 
from  the  blood  into  the  fluid — the  cerebro- spinal  fluid, 
to  give  it  its  technical  name — which  bathes  the  brain  and 
the  spinal  cord  as  they  lie  within  their  lining  membranes 
in  the  skull  and  the  spine  ;  and  the  amount  of  the  drug 
which  enters  this  cerebro-spinal  fluid  is  strictly  pro- 
portional to  the  amount  contained  in  the  blood.  From 
experiments  on  animals  and  from  observations  on  man, 
it  has  been  found  that  the  onset  and  the  intensity  of  the 
symptoms  of  intoxication  are  roughly  dependent  on  the 
quantit}'  of  alcohol  present  in  the  circulation.  Thus 
in  experiments  on  dogs  and  horses  it  was  ascertained 
that  the  animals  began  to  be  slightly  affected  when  the 
proportion  of  alcohol  in  the  blood  reached  the  level 
of  *i2  per  cent.,  that  with  higher  proportions  the 
symptoms  became  more  marked,  and  that  profound 
stupor  frequently  ending  in  death,  ensued  when  the 
alcohol  content  rose  to  72  per  cent.1  Similarly  in  cases 
of  drunkenness  in  man,  the  blood  has  been  found  to 
contain,  in  one  observation  '153  per  cent,  of  alcohol,  and 
in  another  instance,  when  the  intoxication  was  more 
pronounced,  '227  per  cent.2 ;  and  it  is  generally  accepted 
that  with  a  blood  content  of  over  '6  per  cent.,  there  is  a 
considerable  likelihood  of  death.3 

1  Quoted  in  Kobert,  Lehrbuch  der    Intoxikationen,   Vol.    2, 
p.  986.     Stuttgart,  1906. 

2  Schweisheimer,  Deutsches  Archiv  f.  Klin.  Medizin,  Vol.  109, 
p.  271.    1913. 

3 As  qualifying  this  statement,  see  under  "Tolerance,"  p.  91. 


88 

These  figures,  however,  do  not  convey  much  meaning 
until  we  have  translated  them  into  terms  of  doses  as 
drunk.  This  we  can  easily  do  if  we  refer  back  to 
what  was  said  in  Chapter  II  concerning  the  absorption  of 
alcohol  into  the  blood  and  its  subsequent  fate  in  the 
body.  It  was  explained  in  that  chapter  (p.  20)  that 
alcohol  passes  rapidly  from  the  stomach  and  bowel  into 
the  circulation,  and  that,  owing  to  the  slowness  with 
which  it  is  burned  or  excreted,  the  amount  present  in 
the  blood  soon  reaches  a  maximum  level,  bearing  a 
pretty  constant  relation  to  the  dose  originally  drunk.  So 
that,  knowing  the  quantity  of  absolute  alcohol  taken  and 
the  body  weight  of  the  drinker,  we  can  at  once  give  an 
approximate  estimate  of  the  maximum  proportion  of 
the  drug  which  will  be  found  in  the  circulation ;  and 
conversely,  we  can  say  what  amount  of  alcohol  must 
be  administered  to  give  any  particular  percentage  in 
the  blood.  Thus,  taking  the  figures  which  we  have 
quoted,  the  proportion  of  "15  per  cent,  which  was  found 
in  the  blood  in  the  less  pronounced  case  of  intoxication, 
would  correspond  to  an  original  dose  of  1*5  cubic  centi- 
metres of  absolute  alcohol  for  each  kilogramme  of  body 
weight,  and  this  amount,  expressed  in  English  measure, 
would  be  roughly  equivalent,  in  the  case  of  a  man 
weighing  10  stone,  to  a  total  dose  of  3^  ounces  of 
absolute  alcohol,  that  is  to  say,  nearly  a  gill  and  a 
half  of  whisky  at  proof,  or  rather  more  than  4  pints  of 
beer  of  average  strength  (i.e.  containing  4  per  cent, 
absolute  alcohol). 

Lethal  dose  of  atcokoc. 

Again,  if  we  accept  '6  per  cent,  as  being  approximately 
the  alcohol  content  of  the  blood  in  dangerous  poisoning, 
we  shall  put  the  fatal  dose  of  the  drug,  for  a  man  of  the 
weight  given  above,  at  about  14  ounces  of  absolute 
alcohol,  or  nearly  a  pint  and  a  half  of  proof  spirit.  The 
quantity  of   beer   which   would   contain  this  amount  of 


89 

alcohol  would  be  over  two  gallons,  so  that  it  is  easy  to 
understand  that  fatal  cases  of  acute  alcoholic  poisoning 
are  not  likely  to  occur  from  the  drinking  of  a  beverage 
of  this  dilution. 

Effect  of  dilution  on  intoxicating  action  of  alcohol. 

So  far  we  have  been  considering  the  factor  of  dilution, 
in  its  relation  to  drunkenness,  simply  as  affecting  the 
quantity  of  alcohol  which  the  drinker  consumes,  and 
this,  no  doubt,  is  its  most  important  aspect.  It  has  been 
suggested,  indeed,  that  it  may  have  a  wider  influence, 
and  that  the  inebriating  action  of  a  given  dose  of  the  drug 
may  differ  to  some  extent  according  as  it  is  taken  in  a 
weak  or  strong  solution,  but  the  available  evidence  gives 
little  support  to  this  view.  Any  such  influence  would 
probably  be  due  largely,  if  not  entirely,  to  the  effect  of 
dilution  on  the  rate  at  which  alcohol  is  absorbed  into  the 
blood,  and  on  the  degree — in  any  case,  as  we  have  seen, 
a  very  limited  degree  —  to  which  it  is  eliminated 
unchanged  from  the  body. 

But  the  most  recent  experiments1  go  to  shew  that  dilu- 
tion does  not  appreciably  affect  the  rate  of  absorption,  and 
though  it  is  true  that  a  free  action  of  the  kidneys,  which 
would  be  promoted  by  the  taking  of  a  large  bulk  of  fluid 
may  lead  to  a  slightly  increased  excretion  of  unchanged 
alcohol  in  the  urine,  this  increase  is  hardly  sufficient  to 
have  any  real  effect  on  the  concentration  of  the  dug  in, 
the  blood.  The  question,  however,  is  certainly  one  to 
which  further  research  might  usefully  be  directed.2 

Inebriating  action  of  different  alcoholic  beverages. 
And  a  similar  remark  may  be  made  with  reference  to  the 
supposed  influence  of  the  various  bodies  which  are  asso- 
ciated with  ethylic  alcohol  in  wines  and  beers  and  spirits. 

1Widinark.    Skandinav.  Archiv  f .  Physiologie.  Vol.33  p.  85.  1916. 
2  See  footnote  to  Preface,  p.  vi. 


90 

We  are  practically  quite  ignorant  as  to  whether  any  of 
these  other  substances  modify  the  inebriating  action 
of  alcohol,  either  by  accelerating  or  retarding  absorp- 
tion, or  in  other  ways.  We  do  not  know,  for  instance, 
whether,  as  is  popularly  supposed,  the  drunkenness  due  to 
beer  differs  in  type  from  that  due  to  whisk)7  when  doses 
of  equivalent  alcoholic  strength  are  given  in  both  cases, 
and,  if  there  be  any  difference,  we  do  not  know7  on  what  it 
ma>'  depend.  It  has  been  asserted  that  the  alcohol  of  beer 
may  be  absorbed  more  slowly  owing  to  the  amount  of 
gummy,  or  "  colloid  "  matters  contained  in  that  liquor, 
but  such  experimental  evidence  as  exists  does  not  support 

this  view. 

Mixing  of  liquors. 

Similarly  wre  do  not  know  whether  there  is  any 
foundation  in  fact  for  the  popular  belief  that  "mixing 
liquors,"  and,  more  particularly,  the  combination  of 
spirits  with  beer,  is  more  likely  to  cause  drunkenness 
than  the  taking  of  an  equivalent  amount  of  alcohol  in 
one  or  other  of  these  drinks  alone.  Another  point  on 
wrhich  we  need  more  exact  knowledge  is  with  regard  to 
the  inebriating  effect  of  the  impurities  met  with  in  some 
of  the  alcoholic  beverages,  and  especially  in  badly  recti- 
fied spirits. 

Practical,  conclusions  regarding  advantages  of  the  more 
dilute  alcoholic  beverages. 
As  our  practical  conclusion,  then,  from  the  evidence  at 
present  available,  we  may  say  that  any  form  of  alcoholic 
liquor  can  cause  drunkenness,  if  such  a  quantity  of  it  is 
taken,  at  once  or  within  a  short  time,  as  will  lead  to  the 
presence  of  the  drug  in  the  blood  above  a  certain  pro- 
portion, which  in  the  case  of  the  average  healthy  adult, 
may  be  put  provisionally  at  from  "15  to  '2  per  cent.  From 
the  point  of  view  of  the  prevention  of  drunkenness,  the 
superiority  of  the  more  dilute  beverages,  such  as  the 
lighter  beers  and  natural  wines,  is  therefore  mainly  due 


9* 

to  the  fact  that  the  bulk  of  the  fluid  makes  it  difficult  for 
the  drinker  to  consume  a  very  large  dose  of  alcohol  with- 
in a  moderate  period.  This,  as  we  saw  when  referring 
to  the  question  of  fatal  intoxication,  is  an  extremely 
important  superiority. 

Differences  in  susceptibility  to  alcohol. 
In  the  preceding  remarks  we  have  had  in  view  the  aver- 
age normal  drinker — the  person  who  is  neither  specially 
susceptible  nor  specially  resistant  to  the  inebriating 
action  of  alcohol.  But  it  is  notorious  that  departures 
from  this  average  standard  are  very  frequent :  some 
people  are  so  constituted  that  they  are  affected  by  quite 
small  quantities  of  the  drug,  while  others  can  take  large 
doses  without  showing  any  signs  of  intoxication. 

Tolerance. 

Moreover,  as  a  result  of  continued  use,  some  degree  of 
tolerance  can  be  acquired,  so  that  the  habitual  drinker  is 
often  able  to  consume,  without  becoming  obviously 
intoxicated,  quantities  of  liquor  which  would  cause  well- 
marked  drunkenness  in  a  person  unaccustomed  to  the 
drug.  Thus,  instances  have  been  known  where  steady 
drinkers  have  been  in  the  habit  of  taking  alcohol  in  daily 
doses  exceeding  10  cubic  centimetres  per  kilogramme  of 
body  weight,  that  is  to  say,  for  a  man  of  10  stone  weight, 
no  less  than  23  ounces  of  absolute  alcohol,  or  well  over 
two  pints  of  whisky  at  proof,  more  than  enough  to  kill 
a  neophyte. 

We  know  very  little  as  yet  about  the  bodily  changes 
that  accompany  the  development  of  tolerance.  One 
factor  may  be  the  increased  capacity  of  the  tissues  to 
burn  alcohol,  for  it  has  been  shewn  that  when  the  system 
has  become  accustomed  to  the  drug,  it  can  oxidise  it 
much  more  rapidly,  so  that  after  a  given  dose,  the 
amount  present  in  the  blood  does  not  rise  to  the  same 
level  in  an  habitual  drinker,   as  it  would   reach    in    the 


92 

case  of  a  person  who  had  not  acquired  tolerance.  That 
this,  however,  can  only  be  a  contributory  element  is 
evident  from  the  fact,  proved  by  experiment,  that  a 
tolerant  animal  may  show  few  or  no  signs  of  intoxi- 
cation even  when  its  blood  contains  enough  alcohol 
to  cause  well-marked  symptoms  in  an  unaccustomed 
animal.1  It  is  obvious,  therefore,  that  when  tolerance  has 
become  established,  either  the  access  of  alcohol  to  the 
nervous  centres  is  in  some  way  impeded,  or,  as  is  more 
likely,  the  nerve  cells  react  less  readily  to  its  presence; 
but  we  do  not  know  anything  of  the  conditions  on  which 
this  change  depends. 

Tolerance  not  acquired  by  all  cells. 
In  the  case  of  some  other  narcotics,  as,  for  instance, 
morphine,  it  has  been  proved  that  while  certain  nerve 
cells  acquire  tolerance  after  long  use  of  the  drug,  others 
remain  as  susceptible  as  at  the  beginning.  This  has  not 
been  shown  to  occur  in  alcohol  tolerance,  in  which  it  is 
probable  that  all  nerve  cells  lose  their  reaction  to  the 
drug  in  nearly  equal  measure.  But  it  is  certain  that,  while 
the  nerve  cells  of  the  habitual  drinker  become  tolerant  to 
the  presence  of  alcohol,  other  body  cells  are  less  able  to 
accommodate  themselves  to  it,  with  the  result  that  they 
are  very  liable  to  be  injuriously  affected,  if  the  develop- 
ment of  tolerance  in  the  nervous  system  leads,  as  it 
naturally  tends  to  lead,  to  the  taking  of  larger  doses  of 
the  drug.  That  is  why  drinkers  who  have,  as  they 
would  say,  strong  heads  for  liquor  and  who  can  consume 
a  great  deal  of  alcohol  without  becoming  drunk,  are  very 
likely  to  suffer  in  the  long  run  from  some  of  those  bodily 
disorders  we  shall  presently  have  to  consider  in  dealing 
with  the  subject  of  chronic  alcoholism.  And,  on  the 
other  hand,  people  who  are  specially  susceptible  to  the 
intoxicating    action    of    alcohol   are   to   a   great    extent 

1  Pringsheim.    Biochemisclie  Zeitschrift,  Vol.   12,  pts.  1  & 
1908. 


93 

protected  from  excess  by  that  very  fact.  Just  because 
they  are  so  easily  made  drunk,  they  escape  the  more 
serious  evils  of  chronic  poisoning.  Hence,  from  the 
point  of  view  of  general  health,  the  acquisition  of  toler- 
ance really  implies  the  removal  of  a  protective  mechanism 
— it  allows  the  drinker  to  use  the  drug  in  doses  which  he 
could  not  have  taken  if  his  brain  cells  had  retained  their 
normal  power  of  reacting  to  it. 

Special  susceptibility    to   alcohol ;    pathological 
drunkenness. 

A  further  point  which  should  be  noted  before  we  leave 
this  question  of  drunkenness  is  that  under  certain  con- 
ditions, as,  for  instance,  after  an  injury  to  the  head  or 
after  an  attack  of  mental  disease,  a  special  susceptibility 
to  alcohol  may  be  developed  in  persons  whose  reaction 
to  the  drug  had  previously  been  normal.  And  this 
change  may  also  come  about  in  the  later  stages  of  chronic 
poisoning,  especially  after  an  attack  of  delirium  tremens, 
so  that  the  habitual  drunkard,  from  being  more  resistant 
to  the  influence  of  alcohol,  may  become  very  much  less 
resistant.  It  is  a  fact  of  some  importance  that  this 
special  susceptibility  to  alcohol,  and  notably  the  suscepti- 
bility which  results  from  injury,  or  appears  in  an  advanced 
stage  of  chronic  alcholism,  is  shown  not  merely  in  the 
readiness  with  which  small  doses  give  rise  to  mental 
symptoms,  but  is  also  very  often  manifested  in  the 
character  of  these  symptoms,  which  may  differ  more  or 
less  widely  from  the  symptoms  of  ordinary  drunkenness. 
Very  usually,  for  instance,  there  is  in  these  conditions  of 
"pathological  drunkenness,"  as  it  is  called,  a  special 
degree  of  involvement  of  the  highest  nervous  centres — the 
parts  of  the  brain  whose  activity  is  related  to  our  conscious 
life — so  that  prolonged  phases  of  mental  confusion  with 
excitement  and  impulsiveness  are  more  likely  to  occur 
than  in  the  intoxication  of  normal  individuals.  For  this 
reason    the  pathological   drunkard,  especially  when  his 


94 

morbid   predisposition  is  due  to  chronic  alcoholism,  is 
very  apt  to  commit  acts  of  a  seriously  criminal  character. 

Chronic  Alcoholism. 

Having  said  this  much  about  acute  poisoning  by  alcohol, 
we  now  pass  to  consider  the  question  of  chronic  intoxica- 
tion. As  was  pointed  out  in  the  introductory  section, 
there  may  be  no  relation  between  the  acute  symptoms 
set  up  by  a  single  excessive  dose  of  a  drug,  and  the 
chronic  disorders  that  result  from  slower  poisoning  by 
repeated  and  usually  smaller  doses  of  the  same  drug  ; 
and  this  is  conspicuously  the  case  with  alcohol.  The 
symptoms  of  drunkenness  are  due  to  the  immediate  action 
of  alcohol  in  the  body,  an  action,  the  effect  of  which,  as 
we  have  seen,  is  mainly  apparent  in  disturbance  of  the 
functions  of  the  brain  ;  when  the  drug  is  eliminated  from 
the  system,  all  trace  of  this  action  disappears  and  the 
patient  returns  to  his  normal  state. 

It  is  quite  otherwise  in  chronic  alcoholism.  Here 
we  have  to  do  with  changes  in  the  drinker's  tissues 
which  may  be  of  a  permanent  character,  and  which  at  all 
events  persist  long  after  the  alcohol  has  been  entirely 
removed  from  the  system  ;  and  these  changes  are  not 
limited  to  the  nervous  centres,  but  may  affect  in  one  way 
or  another  most  of  the  organs  of  the  body. 

Chronic  alcoholism  due  to  a  generalised  devitalising  action  : 
its  association  ivith  other  deleterious  influences. 
It  would  be  beyond  the  scope  of  this  book  to  give 
any  detailed  account  of  the  disorders  which  are  collec- 
tively described  under  the  term  chronic  alcoholism. 
Briefly,  it  may  be  said  that  they  represent  the  results  of 
a  general  devitalising  action  on  the  tissues,  and  that 
they  vary  from  a  relatively  moderate  impairment  of  the 
normal  state  of  the  organs  to  gross  morbid  changes 
which  ultimately  cause  death.  Of  course,  the  habitual 
drunkard    is    exposed    during   his    life    to   many   other 


95 

deleterious  influences  besides  that  of  alcoholic  excess ; 
and  several  of  these  influences  resemble  alcohol  more  or 
less  closely  in  their  mode  of  action ;  so  that  it  may  be  a 
matter  of  considerable  difficulty  to  assess  the  due  im- 
portance of  the  alcoholic  factor  in  the  causation  of  the 
diseased  conditions  which  are  found  in  specially  frequent 
association  with  intemperance.  This  fact  has  not  always 
been  adequately  recognised  in  the  past,  with  the  result 
that  many  morbid  effects  have  been  set  down  to  the 
account  of  alcoholism  which  are  really  due,  wholly 
or  in  far  greater  measure,  to  other  causes.  The 
responsibility  of  syphilis  in  particular  has  often 
escaped  recognition  in  this  way,  and  diseases,  such, 
for  instance,  as  general  paralysis  of  the  insane,  which 
we  now  know  to  be  invariably  dependent  on  syphi- 
litic infection,  were  long  regarded  as  capable  of 
being  brought  about  by  alcoholic  excess.  Such  con- 
fusion can  occur  the  more  readily  because,  as  pointed 
out  in  the  recent  Report  of  the  Royal  Commission  on 
Venereal  Diseases,  the  intemperate  drinker,  by  reason  of 
his  lessened  power  of  self-control,  is  specially  prone  to 
expose  himself  to  the  risk  of  contracting  these  diseases, 
and,  owing  to  his  lowered  vitality,  is  liable  to  suffer  from 
them  in  aggravated  form. 

Moreover,  the  way  in  wmich  alcohol  acts  in  chronic 
intoxication  is  complex  :  its  injurious  effects  are  only 
partially  the  direct  result  of  the  drug  entering  the 
system  ;  they  are  largely  brought  about  through  its 
detrimental  action  on  the  lining  membrane  of  the 
stomach  and  bowel,  causing  chronic  catarrh  and  failure 
in  the  action  of  the  digestive  juices,  and  so  promoting 
the  absorption  from  the  alimentary  canal  of  poisonous 
matters  (digestive  and  microbial  toxins,  as  they  are 
termed),  which,  in  healthy  conditions  of  the  mucous 
membrane  would  be  formed  in  lesser  amount,  if  at  all, 
and  would  certainly  not  be  allowed  to  pass  so  freely  into 


96 

the  system.  It  is,  indeed,  a  question  whether  many  of 
the  morbid  changes  which  occur  in  other  organs  in  the 
course  of  chronic  alcoholism  may  not  really  be  secondary 
to  these  local  disorders  in  the  gastro-intestinal  tract ;  for 
it  has  been  found  in  some  recent  experimental  inquiries 
that  when  alcohol  was  administered  to  guinea-pigs,  not 
by  the  mouth  but  by  inhalation,  no  visible  alterations 
were  produced  in  the  animal's  tissues,  even  when  the 
intoxication  was  kept  up  for  periods  as  long  as  three 
years — that  is  to  say,  during  half  the  average  life  of  an 
animal  of  this  species — and  although  its  effects  were 
thought  to  be  shown  by  the  frequent  occurrence  of 
abnormalities  of  development  in  the  offspring.1 
Experimental  alcoholism. 
When  these  considerations  are  borne  in  mind,  it  will 
be  readily  understood  that  it  is  very  difficult  to  define  the 
limits  of  chronic  alcoholism,  and  to  distinguish  its  effects 
from  those  of  the  other  morbid  influences  which  may  be 
mixed  up  with  it.  Efforts  have  been  made  to  overcome 
this  difficulty  by  having  recourse  to  the  experimental 
method  ;  and  numerous  investigations  have  been  made 
to  determine  whether  the  continued  administration  of  the 
drug  to  rabbits,  guinea-pigs  and  other  animals  will 
produce  in  their  tissues  morbid  changes  similar  to  those 
found  in  chronic  alcoholism  in  man.  There  are,  it  is  true, 
obvious  limitations  to  this  method :  its  conditions  are 
necessarily  very  artificial,  and  moreover,  the  differences 
between  man  and  other  animals,  especially  in  regard  to 
the  development  of  the  brain — the  organ  on  which 
alcohol  exercises  its  most  important  action — are  enormous, 
so  that  it  is  only  with  considerable  reserve  that  con- 
clusions drawn  from  animal  experiment  can  be  applied 
to  human  beings.  Despite  such  drawbacks,  however, 
these  researches  have  given  certain  positive  results  of 

1  Stockard.       American    Naturalist,    Vol.    47.       1913.      Proc. 
Society  of  Exper.  Biology  and  Medicine,  Vol.   11.     1914. 


97 

unquestionable  value,  particularly  with  regard  to  the 
effect  of  chronic  poisoning  on  the  liver  and  on  the 
reproductive  glands.  The  bearing  of  the  facts  will  be 
best  brought  out  if  they  are  considered  in  relation  with 
the  data  derived  from  the  observation  of  alcoholic 
diseases  in  man. 

Individual  variations  in  susceptibility  to  chronic  intoxication. 

The  first  important  point  to  be  noted  is  that  the  results 
of  laboratory  experiment  are  in  full  agreement  w7ith  medical 
experience  in  proving  the  existence  of  wide  individual 
variations  in  susceptibility  to  the  injurious  effects  of 
alcohol.  Just  as  instances  are  occasionally  met  with 
where  persons  have  drunk  what  would  be  generally 
regarded  as  dangerously  excessive  quantities  of  alcohol 
for  years,  and  have  3^et  shown  no  signs  of  being  the 
worse  in  health,  so  likewise  in  experimental  researches  it 
has  been  found  that  some  animals  do  not  appear  to  suffer 
from  daily  intoxication  over  long  periods  of  time,  while 
others  of  the  same  species  succumb  after  a  few  weeks. 
Individuals,  whether  experimental  animals  or  men,  differ 
also  very  widely  in  the  susceptibility  of  the  several 
tissues  and  organs  to  the  action  of  the  poison  ;  in  one 
subject,  the  liver  may  be  specially  attacked,  in  another 
the  nervous  system,  and  so  on. 

Mental  disorders  in  chronic  alcoholism ;  relation  of 
alcoholism  to  insanity. 

Some  affection  of  mind  is  usually  present  in  chronic 
alcoholism,  but  it  is  commonly  moderate  in  degree,  and 
may  be  shewn  only  in  weakened  will-power  and  failure 
of  memory.  More  intense  but  transitory  disorders 
occur  in  deliriiwi  tremens,  and  in  an  allied  condition  of 
mental  confusion  associated  with  wide-spread  nerve-in- 
flammation. And  in  relatively  rare  instances,  alcoholism 
seem^  to  be  responsible  for  a  chronic  insanity  with 
persistent  delusions,  usually  of  persecution  and  jealousy. 


98 

In  general,  however,  the  part  which  alcoholic  excess 
plays  in  the  causation  of  the  ordinary  forms  of  mental 
disease  is  of  secondary  importance :  it  has  been  shewn 
that  wrhen  the  two  facts  are  associated,  intemperance  is 
more  usually  a  sj-mptom  of  insanity  than  its  cause.1  This 
is  conspicuously  seen  in  certain  cases  of  periodical  (or 
manic-depressive)  insanity,  in  which,  or  in  one  phase  of 
which,  the  most  obtrusive  symptom  of  mental  disorder 
is  an  intense  and  overpowering  impulse  to  alcoholic 
excess.  In  these  relatively  infrequent  cases,  to  which 
the  name  dipsomania  is  sometimes  given,  the  patient 
drinks  heavily  for  a  period  varying  in  different  cases 
but  usually  pretty  constant  for  the  same  case,  and  then, 
when  the  attack  ceases  or  passes  into  another  phase,  he 
returns  to  sobriety — a  fact,  it  may  be  noted  incidentally, 
which  goes  to  shew  that  alcohol  has  no  very  strong  habit- 
forming  influence. 

Morbid  changes  in  nervous  system  in  chronic  alcoholism. 

The  morbid  changes  in  the  nervous  system  which  are 
found  in  chronic  alcoholism  are  very  variable  in  character 
and  degree :  most  commonly  there  is  some  thickening  of 
the  membranes,  with  wasting  of  the  nervous  tissues, 
notably  in  those  parts  of  the  braiu  which  are  supposed 
to  be  specially  related  to  the  higher  mental  activities. 
These  appearances,  however,  are  not  distinctive  ot 
alcoholism,  nor  is  it  possible  to  see  in  them  an  explana- 
tion of  the  nervous  disorders  of  chronic  intoxication  an}*- 
more  than  we  can  discover,  with  our  present  modes  of 
examination,  any  morbid  changes  in  the  brain  tissues  of 
the  insane  which  can  account  for  the  symptoms  of 
insanity.  As  bearing  on  this  point,  it  may  be  noted  that 
the  diseased  conditions  seen  in  the  brain  of  patients  dead 
of  delirium  tremens  are  quite  similar  to  those  just 
referred  to  as  occurring  in  cases  of  alcoholism  without 

1  Mott.     Archives  of  Neurology,  Vol.  3,  p.  424.     1907. 


99 

such  active  disorder,  and,  as  in  these  cases,  are  neither 
constant  nor  very  definite.  It  is  evident,  therefore,  that 
in  chronic  intoxication  the  nervous  tissues  may  be 
damaged  in  ways  which,  while  profoundly  affecting  their 
intimate  constitution  and  their  healthy  functioning,  are 
not  revealed  in  any  visible  structural  change.  We  have 
already  had  an  intimation  of  this  fact  in  the  development 
of  tolerance,  which  is  also  probably  dependent  on  some 
obscure  alteration  in  the  vital  activity  of  the  nerve  cells. 
In  the  affection  of  the  nerves,  especially  the  nerves  of  the 
limbs,  which  occurs  occasionally  as  a  result  of  chronic 
alcoholic  poisoning,  more  particularly  amongst  women, 
and  which  is  technically  known  as  alcoholic  peripheral 
neuritis,  degenerative  changes  are  found  in  the  nerve- 
fibres,  and  also  not  infrequently  in  the  related  cells  of  the 
spinal  cord.  In  animals,  after  prolonged  intoxication 
with  alcohol,  some  observers  have  found  alterations  in 
the  nervous  system,  affecting  both  the  nervous  tissues 
proper  and  the  smaller  blood-vessels ;  but  the  meaning 
of  these  changes  and  their  dependence  on  the  chronic 
poisoning  are  uncertain. 

Disorders  of  the  digestive  system  in  chronic  alcoholism. 

It  is  well  known  that  a  frequent  cause  of  death  in  the 
subjects  of  chronic  alcoholism  is  cirrhosis  of  the  liver 
with  dropsy.  An  organ  is  said  to  undergo  cirrhosis 
when  the  fibrous  connective  tissue  is  increased  and  there 
is  an  associated  degeneration  of  the  cells  upon  which  the 
functions  of  the  organ  depend. 

Chronic  inflammation  of  the  stomach  {gastritis)  is  met 
with  in  heavy  drinkers,  especially  in  those  who  indulge 
in  large  quantities  of  spirits.  It  precedes  and  is,  in  a 
great  measure,  responsible  for  the  disease  of  the  liver. 
The  chronic  irritation  and  subsequent  inflammation  of 
the  mucous  lining  of  the  stomach  sets  up  degenerative 
changes  in  the  cells  which  secrete  the  gastric  juice  ;    and 

16392  h 


IOO 

the  hydrochloric  acid,  essential  for  digestion  and  the 
prevention  of  bacterial  fermentation  may  be  completely 
absent. 

The  blood  circulating  in  the  blood  vessels  of  the 
stomach  and  intestines  is  returned  into  the  general 
circulation  via  the  portal  vein  of  the  liver,  so  that  the 
blood  in  this  organ  contains  poisons  absorbed  from  the 
alimentary  canal  to  a  greater  degree  than  other  organs, 
e.g.  the  kidneys.  The  continuous  circulation  of  these 
poisons  in  the  liver  gives  rise  to  prolonged  irritation  of 
the  connective  tissue  supporting  the  portal  vein,  its 
branches  and  remote  ramifications  throughout  the  organ. 
A  chronic  inflammation  is  thus  brought  about  in  this 
tissue,  accompanied  b}T  a  degeneration  of  the  intrinsic  cells 
of  the  liver,  which  at  first  is  enlarged.  This  enlarge- 
ment in  many  cases  persists  until  fatal  dropsy  sets  in,  or 
the  more  complete  conversion  of  the  chronic  inflamma- 
tory tissue  into  fibrous  tissue  may  eventually  cause  such 
a  shrinkage  of  the  organ,  that  it  becomes  much  smaller 
than  natural,  and  its  surface  is  so  irregular  and  nodular 
as  to  be  termed  "  hobnailed." 

In  experiments  on  animals  a  catarrhal  inflammation  of 
the  mucous  membrane  has  been  set  up,  similar  to  that 
which  is  seen  in  the  stomach  of  the  habitual  drunkard. 
And  some  recent  researches  have  shewn  that  changes 
in  the  liver  corresponding  to  those  of  cirrhosis  in  man, 
can  also  be  produced  in  animals  by  long-continued 
intoxication  with  alcohol.1 

Other  bodily  disorders  in  chronic  intoxication. 

It  is  also  generally  recognized  that  chronic  alcoholism 
is  an  important  cause  of  disease  in  other  organs,  that  it 
contributes,  for  instance,  to  the  development  of  Bright's 

Kyrle  and  Schopper.  Virchow's  Archiv  f.  patholog.  Anatomie, 
Vol.  215,  pp.  309  and  321.     1914. 


101 

disease  of  the  kidneys,  that  it  helps  to  bring  about  the 
degeneration  of  the  blood-vessels  which  leads  to 
apoplexy,  and  that  it  tends  to  promote  fatty  degenera- 
tion of  the  heart,  as  well  as  being  a  very  important 
cause  of  fatty  deposit  on  the  surface  of  that  organ.  All 
these  diseased  conditions,  however,  are  met  with  also 
very  often  in  persons  who  never  take  alcohol  :  they 
may  be  brought  about  by  many  deleterious  agencies, 
operating  singly  or  in  combination,  and  alcoholism  is 
merely  one  of  these  agencies. 

Alcohol  and  resistance  to  infective  disease. 

The  relation  of  alcohol  to  infective  disease  is  of  a 
somewhat  similar  kind :  the  chronic  poisoning,  by 
devitalising  the  tissues,  lowers  the  defences  of  the 
body  against  microbial  invasion  ;  consequently,  specific 
germs,  such  as  those  which  cause  pneumonia  and 
tuberculosis,  as  well  as  the  ordinary  microbes  of  septic 
inflammation  and  blood-poisoning,  find  a  suitable  soil. 
A  slight  general  depressing  influence — a  chill  or  a  local 
injury — which  would  have  no  harmful  effect  upon  a 
healthy  individual,  even  if  micro-organisms  were 
present,  because  the  vital  reaction  of  the  living  tissue 
would  prevent  a  general  infection,  may  be  most  dan- 
gerous to  a  chronic  alcoholic. 

It  has  also  been  suggested  that  resistance  to  infective 
disease  may  be  prejudicially  affected  by  alcohol  when 
taken  in  even  moderate  and  occasional  doses ;  but  the 
experimental  researches  by  which  it  has  been  sought 
to  establish  this  view  have  not  given  any  clear  results. 
On  the  other  hand  there  is  no  evidence  for  the  popular 
belief  which  attributes  to  such  doses  of  alcohol  a  pro- 
tective value  in  cases  of  exposure  to  infection. 

Action  of  alcohol  on  the  reproductive  cells. 
In  the  foregoing  remarks  we   have  been  considering 
alcoholism   merelv  as  affecting  the  individual  :  we  have 


102 


now  to  refer  to  the  wider  influence  which  it  may  exert 
on  the  stock  through  its  action  on  the  reproductive  cells. 
The  earlier  inquiries  regarding  the  reality  and  extent  of 
this  influence  were  mainly  directed  to  determining,  from 
statistical  material,  whether  conditions  of  defective 
development  are  or  are  not  specially  frequent  in  the 
offspring  of  alcoholic  parents.  Evidence  of  this  sort, 
however,  even  if  its  accuracy  were  unquestionable  and 
its  indications  positive  and  clear — and  this  can  rarely  be 
said  of  any  of  the  statistical  data  used  in  this  controversy 
— would  obviously  be  open  to  serious  criticism,  inasmuch 
as  any  excessive  incidence  of  defect  in  the  children  of 
habitual  drunkards  might  be  due,  not  to  the  influence 
of  parental  alcoholism,  but  to  the  presence  of  a  syphilitic 
taint  or  to  an  original  faultiness  in  the  stock.  On  this 
account  it  is  preferable  to  approach  the  question  from 
another  point  of  view,  and  to  rely  mainly  on  such 
data  as  are  obtainable  from  the  systematic  examination 
of  the  genital  glands  in  alcoholic  subjects,  and  from 
breeding  experiments  on  animals.  Researches  in  both 
these  directions  have  been  recently  carried  out,  and  have 
given  results  which,  as  far  as  they  go,  are  definite  and 
concordant. 

The  state  of  the  reproductive  glands  in  habitual  drunk- 
ards has  been  investigated  by  two  independent  observers,1 
who  have  shewn  that  a  condition  of  wasting  of  the  testicles 
with  absence  or  scanty  production  of  the  fertilising  cells 
or  spermatozoa,  is  to  be  found  in  the  majority  of  male 
alcoholics  dying  in  the  prime  of  life,  while  in  the  female, 
alterations  of  a  similar  character  may  be  discovered  in 


1  Bertholet.  I/Influence  de  l'alcoolisme  chronique  sur  les 
organes  de  l'homme,  et  sur  les  glandes  reproductrices  en  particu- 
lier.  Lausanne,  19 13.  Also  communications  by  the  same  author 
to  the  International  Congresses  on  Alcoholism  at  London  (1909), 
and  at  The  Hague  (191 1). 

Weicbselbaum.  Verhandl.  der  deutsch.  pathol.  Gesellschaft, 
Jena,  1910. 


io3 

the  ovaries.  Further,  it  has  been  shewn  by  experiments 
on  rabbits  that,  by  the  continued  administration  of  the 
drug,  morbid  changes  can  be  produced  in  the  genital 
glands  of  these  animals  of  the  same  type  as  those  which 
have  been  observed  in  chronic  alcoholism  in  human 
beings. 

Effect  of  parental  alcoholism  on  offspring. 
The  fact  that  these  glands  are  so  frequently   and  so 
markedly  affected  in  conditions  of  chronic  intoxication 
gives  some  indirect  support  to  the  view7   that  parental 
alcoholism    may   react   injuriously   on    the   vitality    and 
normal  development  of  the   offspring.     And   recent   re- 
search has  furnished  very  important  direct  evidence  to 
the  same  effect.     It  has  been  shewn  by  Stockard,1  in   a 
series  of  experiments  in  which  alcohol  was  administered 
to  guinea-pigs  by  inhalation,   that  the  offspring  of  the 
alcoholised  animals,   in  comparison  with  the  young  of 
control  animals  of  the  same  stock,  were  conspicuously 
inferior  in  strength  and  vitality,  and  in  many  instances 
presented  gross  abnormalities  of   organisation.      These 
bad  effects  were  transmitted  through  several  generations, 
and  were,  indeed,  more  pronounced  in  the  later  genera- 
tions,   than    in    the    immediate    offspring   of    the    alco- 
holised subjects.     An  important  point   brought  out  by 
Stockard  is  that  the  injurious  influence  of  the  intoxica- 
tion may  be  manifest  in   the  offspring  even   when    the 
genital  glands  appear  to  be  quite  healtlry,  thus  shewing 
that,  although  there  are  no  visible  structural  changes  in 
the  germ  cells,  they  have  been   modified   to  an  extent 
sufficient  to  cause  them  to  give  rise  to  defective  embryos 
or  weakened  individuals  who  die  shortly  after  birth. 

These  observations  and  experiments  would  thus  appear 
to  indicate  that  parental  alcoholism  may  have  a  seriously 

1  Stockard,  Joe.  cit. 
Stockard  and  Papanicolaou,  American  Naturalist,  Vol.  50,  1916. 


io4 

detrimental  influence  on  the  stock ;  and  if  the  results  are 
confirmed  by  further  investigation,  it  will  be  reasonable 
to  conclude  that  this  is  probably  one  of  the  most 
important  modes  in  which  intemperance  threatens  the 
health  and  well-being  of  the  community.  But,  in  view  of 
the  extreme  importance  of  this  conclusion,  it  is  clearly 
desirable  to  suspend  judgment  until  the  work  has  been 
controlled  by  other  inquirers. 

Causation  of  chronic  alcoholism. 
After  this  brief  review  of  the  disorders  of  chronic 
alcoholism,  the  next  question  to  be  considered  is,  under 
what  conditions  do  these  disorders  come  about?  What 
mode  and  degree  of  excess  are  liable  to  lead  to  chronic 
poisoning  ?  In  endeavouring  to  answer  this  question 
we  have  not  at  our  disposal  any  direct  evidence 
comparable  to  what  we  had  when  discussing  drunken- 
ness ;  and  we  must,  therefore,  be  content,  at  all  events 
for  the  moment,  with  such  indirect  indications  as  can  be 
gathered  from  a  general  survey  of  the  facts. 

Continuity  of  action  and  excess  of  dose  necessary  factors. 

The  main  conclusion  that  we  arrive  at  in  this  way  is, 
that  there  are  two  essential  factors  in  the  causation  of 
chronic  alcoholism :  first,  the  drug  must  be  taken  in 
sufficient  quantity  to  exercise  an  injurious  action  on  the 
tissues,  and  second,  that  action  must  be  more  or  less 
continuous.  Excess  of  dose  without  continuity  of  action 
does  not  give  rise  to  persistent  tissue  changes ;  as  we 
have  already  seen,  an  isolated  bout  of  drunkenness  does 
not  leave  any  lasting  after-effects.  Again,  the  regular 
use  of  alcoholic  beverages  does  not  induce  chronic 
poisoning  so  long  as  only  moderate  doses  are  drunk  ; 
this  is  a  matter  of  common  experience,  and  we  can  see 
evidence  of  it  on  a  large  scale  in  the  absence,  or  extreme 
rarity,  of  chronic  alcoholism   in  communities  where,  as 


io5 

in  the  non-industrial  populations  of  Southern  France, 
Spain,  and  Italy,  alcohol  is  part  of  the  ordinary  dietary, 
but  is  drunk  in  moderation  and  in  the  form  of  natural 
wines  of  low  strength. 

Conditions  which  promote  chronic  alcoholism. 

In  the  absence  of  exact  data,  we  cannot  safely  go  beyond 
these  general  propositions,  and  we  shall  not,  therefore, 
attempt  to  make  any  estimate  as  to  how  much  alcohol 
there  must  be  in  the  blood,  and  how  long  its  action 
must  be  kept  up,  to  exercise  a  detrimental  effect  on  the 
vitality  of  the  tissues.  For  practical  purposes  it  will 
be  sufficient  if  we  endeavour  to  distinguish  the 
conditions  which  cause  alcoholic  beverages  to  be  taken 
in  such  excess,  with  regard  to  amount  and  frequency  of 
dose,  as  appears  from  actual  experience  to  involve  more 
or  less  injury  to  the  drinker's  health.  In  a  general  view, 
we  may  summarise  the  more  important  of  these  con- 
ditions as  follows. 

(i)  Use  of  the  stronger  alcoholic  beverages. — When  liquors 
of  high  alcoholic  strength  are  drunk,  there  is  an  ante- 
cedent probability  that  an  excessive  dose  of  alcohol  ma}- 
be  more  readily  taken.  The  man  who  drinks  a  light 
beer  must  consume  some  pints  of  fluid  before  he  gets  as 
much  alcohol  into  his  blood  as  the  spirit  drinker  would 
absorb  from  a  glass  of  neat  whisky  at  proof.  And  that, 
no  doubt,  is  one  reason  why  drunkenness  appears  to  be 
relatively  more  frequent  in  spirit  drinkers  than  in  beer 
drinkers,  though  the  difference  is  probably  less  pro- 
nounced than  is  commonly  supposed.  In  a  recent  inquiry 
directed  to  this  point,  it  was  ascertained  that  amongst 
1,505  persons  (1,032  males  and  473  females)  charged  with 
drunkenness,  in  London  and  14  other  large  ciiies  in 
England  during  a  period  of  three   weeks,   intoxication 


io6 

was  attributed  to  beer  alone  in  45*4  per  cent,  of  the  cases 
occurring  in  men,  to  spirits  alone  in  42*0  per  cent.,  and 
to  beer  and  spirits  together  in  io-8  per  cent.,  whilst 
amongst  women  the  proportions  were,  beer  alone, 
37'6  per  cent.,  spirits  alone,  49*0  per  cent.,  and  beer 
and  spirits  together,  8*6  per  cent.  Inasmuch  as  the 
amount  of  alcohol  taken  in  the  form  of  spirits  in  the 
whole  United  Kingdom  is  only  one-third  to  one-quarter 
that  which  is  consumed  in  beer,  it  is  legitimate  to 
conclude  from  these  figures,  drawn  from  the  predo- 
minantly beer-drinking  part  of  the  country  South  of 
the  Tweed,  that  there  is  in  fact  a  greater  likelihood 
of  immediate  excess  when  the  stronger  alcoholic  bever- 
ages are  used.  The  statistical  information  with  regard 
to  the  relative  importance  of  the  several  sorts  of  liquor 
in  the  causation  of  chronic  alcoholism  is  very  scanty, 
but,  as  far  as  it  goes,  it  points  even  more  clearly 
in  the  same  direction,  and  is  thus  confirmatory  of  the 
general  medical  belief  that  spirit,  drinking  is  specially 
liable  to  induce  alcoholic  disease. 

Apart  from  the  greater  risk  of  excess  of  dose  when 
highly  alcoholic  beverages  are  drunk,  the  use  of  ihese 
more  concentrated  liquors  tends,  as  wre  have  already 
seen,  to  promote  chronic  poisoning,  on  account  of  the 
damage  done  to  the  lining  membrance  of  the  stomach 
by  the  direct  action  of  alcohol  in  strong  solution. 

(ii)  Frequent  repetition  of  dose. — It  takes  some  hours 
before  even  a  moderate  dose  of  alcohol  is  completely 
eliminated  from  the  system ;  so  that  if  a  fresh  quantity 
of  liquor  is  drunk  during  this  period  when  the  blood 
still  contains  a  significant  percentage  of  the  original  dose, 
the  alcohol  level  in  the  circulation  will  rise  again.  And 
if  further  doses  continue  to  be  taken  at  similar  intervals, 
the  action  of  the  drug  in  the  body  w7ill  be  kept  up 
persistently.  This  is  what  happens,  for  instance,  in  the 
case  of  industrial  wTorkers  who  have  frequent  recourse  to 


107 

alcohol  during  the  hours  of  labour,  as,  e.g.,  dock  labourers, 
butchers,  etc. :  owing  to  this  frequent  repetition  of  doses, 
which,  taken  individually,  may  be  quite  moderate,  but 
which  by  their  addition  maintain  a  considerable  con- 
centration of  the  drug  in  the  blood,  drinkers  of  this  class, 
industrial  drinkers  as  we  may  term  them  for  brevity's 
sake,  are  peculiarly  apt  to  suffer  from  the  chronic  effects 
of  alcohol.  In  this  respect,  they  contrast  very  strikingly 
with  men  engaged  in  such  occupations  as  coal-mining. 
The  miner's  task  involves  muscular  effort  which  in  its 
character  and  degree  might  appear  a  priori  to  be  equally 
favourable  to  the  use  of  alcoholic  beverages  as  an  element 
in  the  working  diet.  The  conditions,  however,  under 
which  the  work  is  carried  on  are  such  as  preclude 
altogether  the  possibility  of  taking  alcohol  during  the 
hours  of  labour  ;  and  amongst  coal-miners,  accordingly, 
industrial  drinking  is  practically  unknown,  and  alcoholic 
disease  is  exceptionally  infrequent.  Thus,  if  we  refer  to 
the  statistics  of  occupational  mortality  published  by  the 
Registrar-General  (vide  appendix  3),  we  see  that,  while  in 
the  case  of  dock  labourers  the  "comparative  mortality 
figure  "  for  alcoholism  is  more  than  three  times  that  for 
the  general  male  population,  the  corresponding  figure  for 
coal-miners  is  less  than  half  the  same  standard,  and  is, 
in  fact,  one  of  the  lowest  on  the  list.  There  is  no  reason 
to  suppose  that  this  contrast  is  due  to  any  difference  in 
general  sobriety  between  the  two  groups  in  question — the 
incidence  of  drunkenness  is  very  similar  upon  mining 
districts  and  upon  seaports — so  that  it  seems  more 
reasonable  to  attribute  it  mainly  to  the  prevalence  of 
continuous  or  quasi-continuous  drinking  amongst  dock 
labourers,  and  to  the  absence  of  that  type  of  drinking 
amongst  the  coal-miners. 

The  inference  to  be  drawn  from  these  facts  is,  there- 
fore, that,  in  order  to  prevent  the  development  of 
chronic  intoxication,   it  is   essential  that  alcohol  should 


io8 

not  be  taken  in  such  frequently  repeated  doses  as  will 
keep  up  a  constant  excessive  action  in  the  system — 
that  is  to  say,  that  intervals  should  elapse  between  the 
times  when  alcoholic  liquors  are  drunk,  such  that  the 
average  concentration  of  the  drug  in  the  blood  remains 
well  below  the  point  at  which  there  is  any  risk  of 
injury  to  the  tissues. 

(iii)  Drinking  without  food. — Food,  when  taken  with 
alcohol,  dilutes  it,  and  so  decreases  the  irritant  action 
of  strong  alcoholic  beverages  upon  the  lining  membrane 
of  the  stomach ;  the  lack  of  this  protective  influence 
is  probably  an  important  factor  in  the  greater  suscep- 
tibility of  the  industrial  drinker,  who  commonly 
takes  much  of  his  alcohol  on  an  empty  stomach,  par- 
ticularly the  early  morning  dram,  or  "livener,"  with 
which  it  is  customary  in  some  districts  to  start  the  day's 
work. 

(iv)  Sedentary  Occupation. — It  is  popularly  supposed 
that  intemperate  persons  of  sedentary  habits  are  more 
liable  to  suffer  from  the  effects  of  alcoholic  excess 
than  drinkers  engaged  in  active  outdoor  accupations. 
And  to  a  certain,  though  very  limited  extent,  this 
view  is  supported  by  what  we  know  of  the  conditions 
which  may  modify  the  oxidation  and  elimination  of 
the  drug.  Thus  we  have  seen  that  vigorous  muscular 
exertion  causes  alcohol  to  be  burned  rather  more 
quickly  in  the  bod}',  and  also  increases  the  proportion 
which  passes  out  unchanged  in  the  breath.  The  effect 
produced  in  either  of  these  ways  is  not,  however,  so 
considerable  that  it  can  to  an  important  degree  protect 
the  drinker  from  the  injurious  results  of  the  habitual  use 
of  the  drug  in  excessive  and  frequently  repeated  doses;  and, 
in  fact,  as  shewn  by  the  statistics  of  occupational  mortality 
already  referred  to,  the  death-rate  from  presumably  alco- 
holic disease  is  specially  high  in  several  of  these  industries 


109 

which  involve  hard  muscular  labour  in  the  open  air. 
Thus  the  theoretical  advantage  which  this  active  sort  of 
work  confers  on  the  drinker,  in  accelerating  the  removal 
of  alcohol  from  his  system,  is  in  practice  much  more  than 
counterbalanced  by  the  tendency,  which  such  work 
creates,  to  the  continued  and  excessive  use  of  the  drug  as* 
a  supposed  aid  to  labour. 

And  from  this  point  of  view  the  risk  of  chronic 
intoxication  is  in  some  sort  enhanced  by  what  would 
appear  prima  facie  to  be  a  desirable  quality  in  alcohol, 
viz.,  its  food  value.  As  we  have  already  seen,  it  can 
be  used  to  furnish  as  much  as  one-fifth  of  the  total 
amount  of  the  energy  required  by  the  body,  so  that  the 
industrial  drinker,  over  and  above  the  relief  from  the 
sensations  of  fatigue  which  the  drug  gives  him,  obtains 
in  his  alcoholic  liquor  a  suppl3r  of  fuel  food  which  enables 
him  to  reduce  substantially  his  consumption  of  other 
forms  of  nutriment.  The  fact,  therefore,  that  alcohol 
has  a  high  fuel  value,  tends  in  an  important  measure 
to  promote  its  habitual  use  as  a  food  for  very  laborious 
work  in  substitution  for  other  foods,  and  as,  unlike 
these  other  foods,  it  is  not  stored  in  inert  form  in  the 
bod)*,  but  remains  unaltered  in  the  tissues,  it  can 
exercise  for  some  time  a  deleterious  influence  on   their 

vitality. 

Habit-forming  influence  of  alcohol. 
To  complete  this  examination  of  the  factors  which 
contribute  to  the  development  of  chronic  intoxication,  it 
is  necessary  to  say  something  of  habit  in  relation  to 
alcohol.  A  number  of  drugs,  especially  drugs  of  narcotic 
action,  when  they  have  been  taken  repeatedly  for  a 
sufficient  length  of  time,  tend  to  create  in  the  subject  a 
need  or  " craving"  for  their  continued  use;  such  drugs 
are  described  as  habit-forming,  and  the  condition  existing 
when  the  need  or  "craving"  has  become  established,  is 
called  the  drug-habit.     It  is  to'be  noted  that  a  drug-habit, 


no 

in  this  special  sense  of  the  term,  means  a  good  deai  more 
than    the    habit   of   taking  a  particular  drug :  thus,  for 
example,   a   person    who   suffers   from  some  chronic  or 
frequently   recurring  disorder   which    is  relieved    by    a 
specific   medicine,  will   be   likely   to  use   that  medicine 
'regularly,  but  he  will  not  be  considered,  on  that  account 
alone,  to  have  contracted  a  drug-habit ;  his  need  of  the 
drug    is    due    to   the    persistence   of    the   cause    which 
led   him    to   resort   to  its   use   in    the   first   instance,   it 
has  not  been  created  by  the  action  of   the  drug  on  his 
system.     Neither  can  we  properly  bring  into  the  categorj7 
of  drug-habits,  in  the  narrower  meaning  in  which  the 
term  is  here  employed,  those  instances  where  the.  con- 
tinued use  of  a  drug  has  given  rise  to  a   sense  of  need, 
solely  through  that  general  characteristic  of  our  nervous 
organisation  in  accordance  with  which  we  tend  to  repeat 
actions   that  we  have  become    accustomed   to    perform. 
It  is  true  that  this  influence  does  enter  to  some  extent 
into  the  formation  of  true  drug-habits,  as  it  necessarily 
must   in  the   case   of   all  behaviour  which  has  become 
customary  and  agreeable ;  but  it  is  obviously  a  factor  of 
different  nature  from   the  specific  disposition   which  is 
created  by  the  continued  action  of  the  drug,  and  which 
gives  to  the  drug  craving  its  distinctive  character. 

Factors  which  may  contribute  to  the  formation  of  the  alcohol 

habit. 

In  the  development  of  the  alcohol  habit,  all  these 
factors  play  their  parts.  The  habitual  drinker  takes 
alcohol  primarily  for  the  sake  of  the  agreeable  effects 
produced  through  the  nervous  system,  because  he  finds 
that  it  relieves  the  sensations  of  fatigue,  and  because  he 
believes  that  it  gives  him  increased  energy  for  his  work  ; 
and  the  return  or  persistence  of  these  motives  un- 
doubtedly contributes  to  the  regular  use  of  alcohol. 
Similarly,  some  persons  are  said  to  "  fly  to  drink  "   when 


irr 

they  are  worried  or  ill  pain.  In  these  instances  alcohol 
is  taken  with  the  definite  object  of  obtaining  relief  from 
some  disability.  In  other  instances  the  chief  factor  in 
drinking  seems  to  be  an  attitude  of  mind  which  is 
comparable  with  that  induced  by  the  continued  repetition 
of  any  other  act  which  becomes  habitual  in  the  ordinary 
sense.  Such  is  the  case  of  the  drunkard  who  cannot  pass 
his  usual  public-house  or  meet  his  ordinary  boon  com- 
panions without  having  a  glass ;  his  conduct  may  be 
largely  an  instance  of  habit,  and  his  difficulty  in  breaking 
it  off  may  be  scarcely  greater  than  that  of  the  loafer  in 
deserting  his  usual  street  corner.  But  while  these 
factors  undoubtedly  play  an  important  part  in  the 
development  of  habitual  drinking,  there  can  be  no 
question  that  the  continued  abuse  of  alcohol  leads  in 
many  instances  to  changes  in  the  mental  and  bodily 
functions  which  create  a  need  or  craving  for  alcohol. 
The  depression  which  is  present  during  the  recovery  from 
one  drinking  bout  may  be  relieved  by  further  indulgence 
and  thus  lead  to  the  continued  use  of  the  drug.  The 
most  striking  examples  of  craving  are  seen  in  secret 
drinkers,  in  whom  the  abuse  of  alcohol  is  somewhat 
similar  to  that  of  morphine  in  morphine-takers. 

Tolerance  and  abstinence  symptoms  in  drug-habits. 
In  the  case  of  some  habit-forming  drugs,  the  drug 
gradually  loses  its  power  and  no  longer  induces  the 
action  which  followed  its  first  administration.  The  best 
example  of  this  is  offered  by  morphine,  the  most  active 
ingredient  of  opium.  The  morphine  taker,  or  morphino- 
maniac,  through  the  habitual  use  of  the  drug,  becomes 
less  and  less  susceptible  to  its  immediate  effects,  that 
is  to  say,  he  acquires  tolerance  with  regard  to  it,  and, 
by  reason  of  this  tolerance,  he  tends  constantly  to  in- 
crease his  regular  dose.  Further,  when  he  is  deprived 
of  his  usual  allowance,  he  experiences  acute  discomfort, 


112 

and,  if  the  drug  is  suddenly  and  completely  cut  ofi,  he 
sometimes  presents  symptoms  of  serious  collapse  which 
may  even  end  fatally  if  morphine  is  not  administered 
to  him. 

Tolerance  and  abstinence  symptoms  in  drinkers. 
The  development  of  tolerance,  then,  and  liability  to 
abstinence  symptoms  are  often  the  accompaniments  of 
the  true  drug-habit.  The  degree,  however,  to  which 
they  may  be  present  varies  very  widely  in  the  case  of 
different  drugs.  How  does  the  matter  stand  with  regard  to 
alcohol  ?  As  we  have  already  seen,  the  continued  use  of 
alcohol  produces  tolerance?  though  never  to  the  extent 
that  may  be  reached  in  the  morphine  habit.  And  alcohol 
also  may  induce  such  a  condition  in  the  drinker  that  its 
complete  and  sudden  withdrawal  will  give  rise  to  a  feeling 
of  urgent  need,  or  "  craving,"  for  the  drug,  which  is 
usually  regarded  as,  and  probably  is,  at  least  in  part,  a 
genuine  abstinence  symptom.  Though  very  lurid  ac- 
counts of  this  craving  are  sometimes  given  by  neurotic 
drinkers,  it  would  appear  that  ordinarily  the  feeling,  in 
so  far  as  it  really  is  such  a  symptom,  is  very  much 
weaker  than  the  craving  which  habitual  users  of  other 
drugs  experience  as  a  result  of  abstinence.  Thus, 
drunkards  in  prisons  and  other  institutions  where  liquor 
is  not  obtainable,  complain  much  less  of  discomfort 
from  the  lack  of  alcohol  than  from  that  due  to  the 
prohibition  of  smoking. 

Delirium  Tremens  not  due  to  abstinence. 
It  has  also  been  suggested  that  abstinence  symptoms  of 
a  more  definite  and  graver  sort  may  occur  in  alcoholic 
subjects,  and,  more  particularly,  that  the  abrupt  cutting 
off  of  the  drug  in  the  case  of  a  heavy  drinker,  may 
precipitate  an  attack  of  delirium  tremens.  This  has 
been  disputed,  however,  by  many  authorities,  and  several 
arguments  have  been  brought  against  it.     Thus,  delirium 


ii3 

tremens  is  of  very  rare  occurrence  in  institutions  where, 
as  in  the  majority  of  inebriate  retreats,  it  is  the  regular 
practice  to  stop  all  alcoholic  liquor  immediately  on 
the  patient's  admission.  Further,  when  the  disease  has 
developed,  its  course  is  not  affected  by  the  administration 
of  alcohol,  whereas  the  abstinence  symptoms  resulting 
from  the  suppression  of  other  diug-habits,  as,  e.g.,  the 
morphine  habit,  are  relieved  at  once  when  a  dose  of  the 
drug  is  given.  Finally,  recent  investigation  has  shewn 
that  in  many  cases  of  delirium  tremens,  the  fluid  which 
bathes  the  brain  and  spinal  cord  —  the  cerebro-spinal 
fluid— contains  appreciable  amounts  of  alcohol,  so  that 
evidently  its  presence  in  the  nervous  system  does  not 
prevent  the  onset  of  an  attack1. 

Relatively  slight  habit-forming  tendency  of  alcohol. 
Alcohol  thus  differs  from  such  habit-forming  drugs  as 
opium  and  morphine  in  the  fact  that  its  sudden  with- 
drawal causes  less  severe  symptoms,  and  that  no  high 
degree  of  tolerance  is  acquired  by  its  prolonged  use. 
But  these  are  differences  in  degree  rather  than  in  kind. 
And  it  is  to  be  added  that  our  experience  of  morphine- 
takers  in  this  country  is  limited  to  severe  cases  com- 
parable to  the  confirmed  drunkard.  In  each  case  the 
habit  of  abuse  may  in  part  arise  from  the  persistence  or 
recurrence  of  the  conditions  and  circumstances  which 
originally  led  to  recourse  to  the  drug.  But  the  habit  of 
excess  once  formed  tends  to  become  stronger  through 
the  enfeeblement  of  the  w7ill  which  results  from  the 
continued  action  on  the  central  nervous  system  and 
lessens  the  power  to  resist  the  invitation  of  the  narcotic. 


Demole.     L'Encephale.  January,  1914. 


H4 


CHAPTER   IX. 

Alcohol  and  Longevity. 

Does  "moderate"  drinking  affect  the  average   duration    of 

life  ? 

Thus  far  we  have  examined  the  subject  in  the  light 
of  direct  experimental,  pathological  or  clinical  researches, 
and  our  task  has  not  differed  in  kind  from  that  of  any 
writers  on  physiological  or  medical  questions.  But  a 
discussion  of  the  properties  of  alcohol  is  more  or  less 
intimately  related  to  that  of  various  sociological  and 
economic  problems  the  elements  of  which  can  rarely  be 
subjected  to  the  process  of  isolation  and  intensive  study 
which  is  the  essence  of  experimental  science.  Hence 
arises  the  appeal  to  other  kinds  of  evidence.  In  popular 
discussions  a  good  deal  of  use  has,  for  instance,  been 
made  of  statistics.  A  proportion  of  such  statistics  refers 
to  matters  which  do  not  come  within  the  scope  of  our 
inquiry,  such  for  instance  as  alcohol  and  crime ;  but 
something  remains  which  we  are  called  upon  to  examine. 
To  see  how  this  happens,  we  may  recur  to  a  point  made 
in  our  introduction,  viz.,  the  existence  of  loosely  defined 
or  undefined  notions  respecting  the  value  of  alcohol  as 
an  habitual  beverage.  Many  people  think  that  a  daily 
glass  of  beer,  wine  or  spirits  "  does  them  good"  ;  others 
are  not  less  confident  that  the  use  of  such  substances 
does  harm.  Some  of  the  implications  of  these  statements 
have  already  been  noticed,  but  one  remains  for  individual 
attention.  This  is  the  belief  that  "  moderate  "  drinking 
shortens  (or  lengthens)  life  on  the  average. 

Every  reader  of  these  pages  must  have  seen  a  para- 
graph describing  an  interview  with  some  aged  man  (by 
preference  a  centenarian)  where  the  person  interviewed 
attributes  his  length  of  days  to  (a)  total  abstinence  from 
alcohol    or    tobacco,  or    (b)    absolute    regularity    in    the 


H5 

daily  consumption  of — say — one  pint  of  beer  and  one 
pipe  of  tobacco.  Again,  beyond  this  anecdotal  substitute 
for  scientific  evidence,  one  finds  statements  describing 
the  heavy  mortality  suffered  by,  let  us  say,  publicans  and 
inn  servants ;  the  inference,  whether  expressed  or 
implied,  being  that  they  have  shortened  their  lives  by 
the  abuse  of  alcohol;  or,  on  the  other  hand,  we  see 
quoted  the  low  death  rates  of  the  clergy,  it  again  being 
suggested  that  the  large  proportion  of  total  abstainers 
from  alcohol  to  be  found  in  this  class  is  responsible  for 
the  advantage  enjoyed.  The  wide  currenc}'  of  sucn 
statements  and  implications  makes  it  incumbent  upon  us 
to  inquire  whether  there  really  exists  any  evidence  upon 
which  scientific  conclusions  can  be  founded  with 
reference  to  the  relation  between  a  habit  of  consuming 
moderate  quantities  of  alcohol  and  longevity. 

Nature  of  available  evidence. 

The  extreme  difficulty  of  the  subject  can  be  best 
displayed  by  considering  the  kind  of  data  that  would 
need  to  be  provided  for  a  solution  on  the  experimental 
lines  of  the  work  used  as  a  basis  for  the  earlier  chapters 
of  this  book. 

In  effect  we  should  require  to  have  at  our  disposal  a 
number  of  men  or  women  of  like  ages,  similar  ancestry, 
occupations  and  civil  condition.  We  should  divide 
them  at  random  into  two  groups,  the  members  of  one 
group  would  receive  a  fixed  quantity  of  alcohol  daily,  and 
the  fates  of  all  would  be  recorded  from  the  time  of 
beginning  the  experiment  until  everyone  was  dead. 
Naturally  no  such  experiment  has  been  carried  out,  and 
we  are  obliged  to  fall  back  upon  such  partial  substitutes 
as  the  ordinary  chances  of  society  have  placed  at  our 
disposal.  We  shall  not  weary  the  reader  with  a 
description  of  various  admittedly  imperfect  or  quite 
unsuccessful  attempts  that  have  been  made  to  find  such 

16302  1 


116 

substitutes,  but  pass  at  once  to  the  efforts  which  may  at 
least  be  regarded  as  partially  successful.  Among  such, 
certain  statistics  of  insurance  companies  deserve  mention. 
As  everybody  knows,  nearly  all  insurance  companies 
take  special  pains  to  learn  the  state  of  health  and  habits 
of  persons  whose  proposals  are  entertained,  while  there 
are  some  which  classify  separately  policy  holders  who  are 
or  are  not  total  abstainers  from  alcohol.  An  important 
example  is  the  United  Kingdom  Temperance  and 
General  Provident  Institution,  and  its  experience  has 
been  often  quoted  in  the  present  connection.  The 
scientific  papers  dealing  with  this  special  case  are  cited 
in  the  footnote  and  must  be  examined  by  a  reader  who 
wishes  to  master  the  somewhat  technical  problems  which 
can  here  only  be  sketched  in  outline.1 

Experience  of  the  United  Kingdom  Temperance  and  General 
Provident  Institution. 

This  office  accepts,  at  the  same  premium,  abstainers 
from  alcohol  and  non-abstainers,  but,  after  acceptance,  the 
records  of  the  tw7o  classes  are  kept  apart,  bonuses  being 
declared  separately  for  each  class  in  accordance  with  its 
mortality  experience.  This  is  to  say,  that  no  immediate 
inducement  is  held  out  to  entrants  who  are  abstainers ; 
if  they  do  derive  any  advantage  in  the  long  run,  it  will  be 
because  their  average  longevity  is  greater,  so  that  their 
section  of  the  office  earns  larger  bonuses. 

Now  among  males  insured  by  this  company  (whole  life 
policies)  it  was  found  that  26*4  per  cent,  fewer  deaths 
occurred  among  the  abstainers  than  would  have  taken 
place  had  they  died  at  the  rate  observed  in  the  class  of 
non-abstainers.  This  great  difference  does  not  mean  that 
the  non-abstainers  were  bad  lives ;    as  a  matter  of  fact, 


1  Moore,  Journ.  Institute  of  Actuaries,  XXXVIII,  213. 
Lidstone,  ibid.  p.  273,  1904.  Andrae,  Berichte  d.  5ten.  Inter- 
nationalen  Kongresses  f.  Versicherungs-Wissenschaft,  p.  491,  1906. 


ny 

their  mortality  was  almost  the  same  as  experienced  by 
the  clients  of  the  23  British  Offices  whose  pooled 
experience  over  the  years  1 863-1 893  formed  the  basis  of 
a  widely  used  table  of  mortality  for  insurance  purposes 
(that  is,  a  table  shewing  the  chance  of  a  person  dying  at 
various  ages).  To  use  a  statistical  average  which  is, 
possibly,  more  vivid  than  a  mere  comparison  of  per- 
centages of  deaths,  we  may  take  the  expectation  of  life 
at  age  30,  that  is,  the  average  number  of  years  lived  by 
persons  after  the  thirtieth  birthday.  According  to  the 
experience  of  the  total  abstainers,  this  is,  on  the  average, 
a  little  more  than  39  years,  while  for  the  non-abstainers 
it  is  some  3^  years  less  ;  indeed  only  one  life  office,  viz., 
the  Clergy  Mutual,  has  recorded  an  expectation  of  life 
superior  to  that  of  the  Total  Abstainers  of  the  United 
Kingdom  Temperance  and  General  Office. 

Thus  far  we  have  considered  only  males  having  ordinary 
whole  life  policies.  The  experience  of  the  office  with 
women  was  not  so  extensive  and  the  difference  between 
the  two  classes,  abstainers  and  non-abstainers,  although 
in  favour  of  the  former,  was  not  significantly  so;  they  had 
only  3  per  cent,  fewer  deaths  than  their  fellows  (all  these 
comparisons  naturally  allow  for  differences  of  age).  The 
data  for  Endowment  Policies  (the  popular  modern  form 
of  insurance  in  which  the  sum  assured  is  payable  at  a 
certain  age  or  at  death,  whichever  comes  first)  shewed  a 
great  advantage  among  the  abstainers  (18*2  per  cent, 
fewer  deaths  than  expected)  but  not  so  great  an  ad- 
vantage as  seen  in  the  whole  life  policies. 

Difficulties  in  interpretation  of  the  experience  of  the  United 
Kingdom  Temperance  Institution. 

There  is  evidently  no  reasonable  doubt  that  the 
abstainers  insured  in  this  office  do,  on  the  average,  live 
longer  than  the  non-abstainers,  but  it  would  not  be 
scientific    to    attribute    the    result   solelv  to    the    fact   of 


n8 

abstinence  from  alcohol  without  further  analysis.     In- 
surance statistics  have  to  be  interpreted  with  great  care, 
owing  to  the  influence  of  selection  and  collateral  social 
conditions.      Thus,    it  has   been    pointed   out   that   the 
number  of  policies  in  force  in  the  abstainers'  section  of 
this  office  increased  by  29  per  cent,  between  1882  and 
1902,    while    the    number     of     non-abstainers'    policies 
diminished  in  the  same  time  by  23  per  cent.     The  con- 
sequence was  that  the  experience  of  the  abstainers  was 
necessarily  somewhat  more  favourable  than  that  of  the 
non-abstainers   from   an    assurance   standpoint,  for   two 
reasons :  (1)  It  contained  a  larger  proportion  of  recently 
selected  lives,  i.e.  persons  who  had  been  more  recently 
medically  examined ;    (2)  these   persons  lived    during  a 
period  of  lower  general  mortality,  viz.,  after  rather  than 
before  1882.     It  is  of  course  obvious  that  a  man  aged  35 
is  more  likely  to  die  within  a  year  if  he  had  insured 
when  25  than  if  he  had  been  accepted  by  the  insurance 
doctor  when  34  years  old,  since  he  has  had  time  to  fall 
a  victim  to  a  disease  which  the  doctor  will  detect  at  his 
examination,  but  could  not  predict  several  years  earlier. 
Again,  we  know  that  the  expectation  of  life  for  all  classes 
has  improved  with  time,  in  consequence  of  new  medical 
discoveries  which  benefit  all,  and  of  our  modern  higher 
standards  of  public  and  personal  hygiene. 

It  is  not  possible  to  measure  the  effect  of  this  difference, 
but  it  is  proper  to  state  that  when  the  statistics 
were  limited  to  the  period  ending  in  1882  (the  whole 
data  published  relate  to  the  years  from  1848  to  1901),  the 
abstainers  still  had  an  advantage,  although  for  that 
period,  the  above  mentioned  factors  should  rather  tell 
against  them,  because  during  the  first  eight  years  of  its 
existence  the  office  only  accepted  abstainers,  so  that 
there  would  have  been  proportionally  more  new  policies 
among  the  non-abstainers. 

Another    criticism   from  the   insurance   standpoint    is 


119 

directed  to  two  peculiarities  in  the  experience  of  this 
office.  The  first  is  that  the  ratio  of  death  rates  of  males 
to  death  rate  of  females  (abstainers)  is  altogether  unlike 
that  found  in  other  offices,  the  female  mortality,  being 
proportionally,  much  too  high.  The  second  is  that  the 
mortality  experience  of  the  abstainers  holding  endow- 
ment policies  was  not  appreciably  better  than  that  of  the 
abstainers  holding  whole  life  policies.  Both  these  facts 
have  suggested  to  a  well-known  continental  actuary 
Aiidrae)  that  the  abstainers  were,  at  the  time  they 
insured,  ''select'7  lives.  Thus,  the  proportion  subsisting 
between  male  and  female  rates  of  mortality  must  be 
chiefly  due  to  the  differences  of  liability  to  certain 
diseases  and  accidents  dependent  upon  sex  itself  and  to 
secondary  sexual  consequences,  such  as  occupation, 
general  habits,  etc.  It  is  not  easy  to  see  why  this 
proportion  should  be  changed  if  both  men  and  women 
abstain  from  alcohol.  Again,  all  other  offices  have 
found  that  persons  who  take  endowment  policies  die  at 
lower  rates,  on  the  average,  than  do  those  who  take  life- 
long policies.  The  usual  explanation  given  is  that 
self  selection  is  important.  Anyone  who  thinks  either 
because  many  of  his  relations  died  young,  or  perhaps 
because  of  some  private  habits  or  intentions  which  do 
not  come  within  the  scope  of  an  insurance  company's 
inquiries,  that  he  will  not  live  long,  is  not  likely  to  pay 
the  higher  premium  required  for  an  endowment  policy, 
so  that  the  endowment  policy  holders  are  twice  selected. 
Naturally  we  cannot  think  that  abstainers  have  less 
powers  of  self  selection  than  non-abstainers,  so,  in  the 
opinion  of  the  critic,  we  must  conclude  that  the  whole 
life  policy  holders  were  already  a  select  class  when  they 
insured,  and  that  their  lowTer  rate  of  mortality  may  not 
have  had  anything  to  do  with  their  lifelong  abstinence 
from  alcohol. 

It  would  be  exceeding  the  limits  we  have  assigned  to 


120 

this  statement  were  we  to  discuss  the  theoretical  argu- 
ments in  support  or  in  rebuttal  of  this  criticism.  It 
does  not  seem  practicable  to  apply  any  objective  test 
which  could  give  a  decisive  answer,  and  therefore  we 
cannot  regard  the  experience  of  the  office  as  conclusive. 

Possibility  that  ^non-abstaining"  group  mav  include  some 

heavy  drinkers. 

There  are  two  other  criticisms  the  force  of  which  can- 
not be  fully  estimated.  There  is  no  doubt  at  all  that 
excessive  indulgence  in  alcohol  does  very  greatly  shorten 
life.  But  in  any  large  group  of  persons  who  are  not 
total  abstainers  there  must  needs  be  found,  in  the  long 
run,  a  proportion,  perhaps  a  very  small  proportion,  but 
still  some,  giving  way  to  circumstances  and  becoming 
seriously  intemperate.  Such  persons  will,  on  the 
average,  die  below  the  normal  age,  and  their  unfavour- 
able mortality  experience  must  go  to  swell  the  balance 
of  deaths  in  the  general  section.  It  is,  of  course, 
impossible  to  measure  the  significance  of  this  fact,  but 
in  the  present  state  of  knowledge,  we  cannot  neglect  it 
without  begging  the  question  which  we  really  wish  to 
answer,  viz.,  whether  moderate  drinking  shortens  life 
or  not  ? 

Risks  of  venereal  disease  and  accident  in  non-abstainers. 

Also  we  must  bear  in  mind  the  conclusion  of  the  Royal 
Commission  on  Venereal  Diseases,  that  the  abuse  of 
alcohol  plays  an  important  role  in  the  spread  of  venereal 
disease.  A  single  lapse  due  to  the  loss  of  self-control 
consequent  upon  convivial  excess  may  lead  to  infection 
with  disease  which  shortens  life  greatly,  and  such  cases 
would  also  help  to  explain  the  difference  between  life 
prospects  of  abstainers  and  moderate  drinkers.  A  like 
remark  applies  to  various  forms  of  violent  death,  as  in 
street  accidents. 


121 

Mortality  of  persons  engaged  in  the  liquor  trade. 

We  have  now  examined  the  evidence  available  as  to  the 
mortality  experience  of  total  abstainers  compared  with 
ordinary  life  office  experience,  and  must  say  a  few  words 
of  those  whose  employment  brings  them  into  c^lose 
contact  with  alcohol.  It  is,  however,  unnecessary  for  us 
to  devote  much  space  to  this,  because  most  readers  will 
be  acquainted  with  the  figures  of  the  Registrar-General, 
often  quoted  in  the  press,  shewing  the  heavy  mortality 
experienced  in  the  liquor  trades.1  According  to  the 
published  statistics  of  a  large  insurance  company  (the 
Prudential)  the  expectation  of  life  of  insured  persons 
belonging  to  the  liquor  trades  is  at  age  30  as  much  as 
15  years  less  than  that  of  the  abstainers  noticed  above, 
and,  indeed,  many  years  short  of  the  average  for  all 
males  as  computed  in  the  Registrar-General's  life  tables 
for  England  and  Wales.2  The  data  of  the  Actuarial 
vSociety  of  America8  also  shew  that  persons  employed  in 
liquor  saloons  die  at  very  high  rates.  It  was  found 
that  proprietors,  managers  and  superintendents  of 
liquor  establishments  who  did  not  attend  the  bar, 
experienced  a  mortality  which  was  135  per  cent,  of  the 
standard  rate  ;  when  they  did  attend  the  bar,  the  per- 
centage rose  to  178  per  cent.,  while  the  death  rate  from 
cirrhosis  of  the  liver  was  sixfold  the  normal  rate. 

These  figures,  of  course,  confirm  the  view,  which  per- 
haps hardly  needed  statistical  confirmation,  that  excessive 
opportunities  for  indulgence,  on  ihe  principle  "how  oft 
the  sight  of  means  to  do  ill  deeds  makes  ill  deeds 
done,"  will  be  attended  on  the  average  with  special 
risks  to  life  and  health.     But  the  statistics  do  not  tell 

1  See  Appendix  3. 

-McDonald,  Berichte  d.  5ten.  Intern.  Kong.  f.  Versicherungs- 
Wissenschaft,  p.  517.     1906. 

3  Medico-Actuarial  Investigation  of  Association  of  L,ife  Assur- 
ance Medical  Directors  and  the  Actuarial  Society  of  America. 
3  Vols.     New  York,  1912   13.  n 


122 

us  much  more ;  we  cannot  infer  from  them  that  a 
publican  who  drinks  moderately  will  die  sooner  than 
another  man  of  the  same  age ;  indeed,  even  if  we 
could  infer  this,  we  should  still  have  to  consider 
whether  the  unhygienic  surroundings,  poor  accommoda- 
tion and  excessive  hours  of  labour  of  many  liquor  estab- 
lishments rather  than  the  drinking  of  alcohol  might 
not  chiefly  contribute  to  the  result 

Sickness  and  mortality  of  abstainers  and  71011- abstainers  ln 
certain  Friendly  Societies. 
We  next  turn  to  the  statistical  experience  of  certain 
large  Friendly  Societies,  reported  upon  nearly  30  years 
ago  by  Mr.  F.  G.  P.  Neison.1  Comparing  the  Rechabites 
(a  societ}^  of  total  abstainers)  with  the  Oddfellows  and 
Foresters,  a  difference  very  similar  to  that  found  in 
the  experience  of  the  United  Kingdom  Temperance 
and  General  Provident  Institution  is  seen.  The  Rech- 
abites had  only  69  per  cent,  of  the  deaths  calculated 
on  the  basis  of  the  Foresters'  experience,  and  theii 
expectation  of  life  at  age  30  was  more  than  4  years 
longer  than  that  of  the  Foresters.  This  comparison, 
howTever,  probably  overstates  the  advantage,  as  the 
Rechabites'  statistics  cover  the  period  1878- 1888,  while 
the  Foresters'  data  were  for  187 1-5  and  the  Odd- 
fellows' 1866-70.  With  regard  to  sickness,  the  aver- 
age weeks  of  sickness  claim  per  member  were  higher 
among  the  Rechabites  up  to  age  groups  40-50,  but 
lower  for  ages  50-60  and  60-70  than  in  the  non- 
abstaining  societies.  The  average  numbers  of  weeks 
of  sickness,  not  per  member,  but  per  member  sick, 
were  about  the  same  among  Foresters  and  Rech- 
abites, and     the     actuary    concluded    that    the    higher 

1  F.  G.  P.  Neison.— The  Rates  of  Mortality  and  Sickness  accord- 
ing to  the  experience  for  the  ten  years  1878-87  of  the  Independent 
Order  of  Rechabites  (Salford  Unity)  Friendly  Society.  Lon- 
don, 1889. 


123 

general  rates  at  earlier  ages  among  the  Rechabites 
were  due  to  less  perfect  medical  examination  at 
entrance,  his  reason  being  that  new  entrants  shewed  a 
much  higher  percentage  of  sickness  claims  than  members 
of  the  same  age  but  longer  standing  in  the  society. 
This,  wThich  is  contrary  to  the  usual  experience  of 
Friendly  Societies,  pointed,  in  his  opinion,  to  less 
careful  selection  of  entrants. 

As  a  whole  these  results  concord  writh  the  life  office 
experience  detailed  above.  The  obvious  criticisms  to 
wThich  they  are  subject  are  (i)  the  Rechabites  wrere  a  very 
much  smaller  society  than  either  of  the  non-abstaining 
societies ;  both  the  Oddfellows  and  the  Foresters'  sta- 
tistics covered  in  each  case  more  than  ten  times  as  many 
years  of  life  and  more  than  fifteen  times  as  many  deaths, 
as  the  Rechabites,  while  the  comparison  does  not  relate 
to  the  same  calendar  years.  (2)  Both  occupational  and 
geographical  distribution  may  be  important  factors  of 
mortality,  especially  in  industrial  populations,  and  neither 
could  be  analysed. 

Conclusions. 

The  observations  wTe  have  offered  and  the  illustrations 
quoted  indicate  the  necessity  of  being  cautious  in  draw- 
ing deductions  in  respect  of  the  relation  obtaining 
between  the  consumption  of  alcoholic  beverages  and 
longevity.  We  think,  however,  that  it  is  legitimate  to 
conclude : — 

(i.)  That  the  death-rate  is  lowTer  and  the  expectation 
of  life  longer  in  the  section  of  an  Insurance 
Society  admitting  only  total  abstainers  from 
alcohol  than  in  the  section  admitting  those  who 
are  not  abstainers  from  alcohol. 
(ii.)  That  the  statistics  of  mortality  are  more  favour- 
able for  abstainers  than  are  the  returns  for  other 
Societies    making    no    such    distinctions,    and 


124 

which   issue   policies   chiefly    to   persons   of    a 

more  prosperous  social  class.1 
(iii.)  That  Friendly  Society  data  are  concordant  with 

those  of  the  Life  Insurance  Offices  in  this  respect. 
(iv.)  That    the    official     statistics     issued     by    the 

Registrar  -  General    indicate    an    exceptionally 

heavy  mortality  among  persons  occupied  in  the 

liquor  trade. 
It  should  be  added  that  it  does  not  follow  from  these 
conclusions  that  a  consistently  moderate  use  of  alcoholic 
beverages  shortens  life,  since  we  cannot  sort  out  from  the 
data  brought  into  comparison  those  instances  in  which 
the  habitual  abuse  of  alcohol  produces  disease  or  death, 
or  in  which  accidental  abuse  has  a  like  consequence,  nor 
can  wre  exclude  many  other  social  factors  operating  for 
or  against  longevity. 

Our  duty  is  merely  to  assess  the  value  of  the  evidence 
dispassionately.  Anyone  is  entitled  to  argue  as  follows  : 
Since  it  is  admittedly  proved  that  in  a  comparison 
extending  over  many  3^ears  and  embracing  different  social 
classes,  non-abstainers  do  not  live  as  long  on  the  average 
as  abstainers,  therefore,  for  the  practical  conduct  of  life  a 
person  desiring  to  live  more  than  the  average  term  of 
years  will  do  well  to  become  a  total  abstainer.  This  is 
quite  possibly  a  sound  rule  of  conduct,  but  what  the 
impartial  student  has  to  keep  in  mind  is  that  the  con- 
nection between  the  postulated  "cause,"  taking  or  not, 
taking  alcohol,  and  the  supposed  "  effect,"  an  average 
longer  or  shorter  life,  has  not  been  displayed  with  the 
clearness  and  freedom  from  disturbing  complex  social 
or  personal  factors  in  addition  to  the  consumption  of 
alcohol,  which  would  entitle  it  to  rank  as  a  scientifically 
established  conclusion. 

1  The  validity  of  the  argument  lias  been  impugned  on  technical 
grounds,  the  practical  importance  of  which  cannot  be  determined. 


125 

CHAPTER  X. 

Conclusions. 

We  have  now  completed  our  survey  of  the  present 
state  of  scientific  knowledge  regarding  alcohol,  considered 
in  its  several  aspects  as  a  food,  a  drug  and  a  poison.  It 
remains  to  sum  up  in  this  final  chapter  the  main  facts 
which  we  have  ascertained,  and  to  draw  from  them  such 
inferences  as  have  a  practical  bearing  on  the  use  of 
alcoholic  beverages  under  the  conditions  of  everyday  life. 

Main  action  of  alcohol  confined  to  nervous  system. 
The  first  conclusion  to  which  this  review  of  the 
evidence  leads  us  is,  that,  apart  from  the  results  of  its 
continued  excessive  use,  the  main  effects  of  alcohol  that 
have  any  real  significance  are  due  to  its  action  on  the 
nervous  sj'stem.  As  we  have  seen  in  the  chapters  deal- 
ing with  these  several  points,  the  result  of  scientific 
research  concerning  the  action  of  alcohol  on  the  respi- 
ration, the  circulation,  the  digestion,  the  muscular  system, 
is  to  shew  that,  so  far  as  direct  action  is  concerned, 
alcohol,  when  administered  in  moderate  doses,  in  dilute 
form  and  at  sufficient  intervals,  has  no  effect  of  any 
serious  and  practical  account. 

Action  of  alcohol  narcotic  and  not  stimulant. 
'o  A  further  conclusion  of  capital  importance  which 
emerges  with  equal  clearness  is  that  the  action  of  alcohol 
on  the  nervous  system  is  essentially  sedative,  and — 
with  the  possible  exception  of  its  direct  influence  on  the 
respiratory  centre — is  not  truly  stimulant.  The  popular 
belief  in  the  stimulating  properties  of  alcohol,  as  regards 
nervous  and  other  functions,  seems  to  be  of  purely  sub- 
jective origin  and  illusory;  it  is  in  the  main,  if  not  wholly, 
an  effect  of  the  narcotic  influence  of  the  drug,  for,  as  we 


126 

have  seen,  it  dulls  the  drinker's  perception  of  unpleasant 
conditions  in  himself  and  his  surroundings,  and  may 
make  him  feel  better,  more  efficient  and  stronger  than  he 
really  is. 

Effects  which  are  apparently  of  a  different  character — 
effects  such  as  the  increased  loquacity  and  freer  gesticu- 
lation produced  by  alcohol — which  are  usually  interpreted 
by  the  drinker,  if  not  by  those  about  him,  as  evidences  of 
stimulation,  are  really  narcotic  effects ;  they  result  from 
the  removal  of  the  control  exercised  by  the  higher  nervous 
centres,  a  control  which  enables  the  individual  to  weigh 
his  words  and  acts,  and  renders  him  self -critical  and 
solicitous  as  to  the  impression  he  is  making  on  other 
people.  The  removal  of  this  control  and  the  decrease  of 
critical  self-consciousness  are,  in  fact,  the  most  constant 
and  characteristic  effects  of  alcohol,  whether  in  the  moder- 
ate dose  which  diminishes  restraint  and  imparts  courage 
to  the  diffident  speaker  or  in  the  excessive  dose  which 
gives  rise  to  the  verbose  diffuseness  of  drunkenness. 

We  may  see  a  further  illustration  of  the  true  nature  of 
the  drug  action  of  alcohol  in  its  seemingly  contradictory 
effects  on  persons  of  different  temperament  when  com- 
peting in  games  of  skill  in  which  temperament  is  an 
important  factor.  The  cool  and  self-controlled  player  will 
generally  find  that  even  a  small  or  moderate  amount  of 
alcohol  will  impair  the  accuracy  of  his  play,  while,  on 
the  other  hand,  it  may  improve  the  performance  of  the 
excessively  nervous  player  by  decreasing  his  over-anxiety 
and  self-consciousness. 

Objective  effects  of  drug  on  nervous  system. 

In  reality,  so  far  as  the  effects  of  the  drug  on  the 
nervous  system  are  objectively  perceptible,  they  are 
always  manifested  in  a  lowering  of  functional  activit)r. 
We  have  seen  that  this  effect  is  appreciable  in  the  case 
of  the  simplest  reflex  actions,  but  that  it  acquires  increasing 


127 

prominence  with  increasing  complexity  of  the  response 
chosen  for  the  test ;  so  that  a  dose  which  produces  no 
obvious  change  in  the  performance  of  a  simple  act, 
involving  no  skill  or  exact  adjustment  of  movement,  will 
definitely  impair  the  precision  of  an  act  demanding  a 
greater  delicacy  of  control  and  co-ordination. 

When  narcotic  action  may  be  useful. 

The  conclusion  indicated  by  our  review  of  the  scientific 
evidence,  that  alcohol  is  essentially  a  narcotic,  does  not 
imply  an  adverse  judgment  as  to  its  value  in  all  circum- 
stances. There  is  nothing  intrinsically  good  about  a 
stimulant,  and  nothing  intrinsically  bad  about  a  narcotic. 
Each  has  its  proper  utility  under  given  conditions.  But 
these  conditions  are  different  for  each,  and  on  that  account 
it  is  important  that  there  should  be  no  confusion  as  to 
wrhether  a  drug  belongs  to  one  category  or  the  other. 
When  stimulation  of  nervous  function  is  really  needed — 
when  the  individual  has  to  meet  an  emergency  which 
calls  for  the  exercise  of  his  highest  powers  of  perception 
and  judgment  —  alcohol  is  not  merely  useless,  it  is 
certainly  and  unequivocally  detrimental.  On  the  other 
hand,  there  are  emergencies  where,  though  the  individual 
may  also  imagine  that  he  needs  to  be  braced  up  nervously, 
he  would  in  fact  be  assisted  far  more  by  a  relaxation  than 
by  an  increase  of  tension,  and  here  the  sedative  action  of 
alcohol,  so  far  as  the  immediate  effect  is  concerned,  may 
be  advantageous.  The  value  widely  attributed  to  the 
rum  ration,  under  the  conditions  of  acute  discomfort,  cold 
and  nervous  strain  inseparable  from  trench  warfare,  may 
be  explained  in  this  way.  It  is  in  this  way  too  that  alcohol 
helps  the  timid  speaker  to  overcome  his  diffidence,  and  to 
free  himself  from  the  inhibitions  that  prevent  him  from 
finding  his  words.  Similarly,  an  exhausting  and  worrying 
dav  mav  leave  a  condition  of  tension  and  irritabilitv  which 


128 

interferes  with  appetite  and  digestion  ;  and  in  such  a  con- 
dition, and  in  some  persons,  it  may  be  that  wine  or  other 
dilute  form  of  alcohol  taken  with  the  evening  meal,  will 
assist  the  assimilation  of  food.  Again,  persons  who  have 
overworked  to  such  an  extent  that  they  have  become  too 
tired  to  rest,  ma}T  be  enabled  to  sleep  when  they  have 
taken  a  small  amount  of  alcohol — a  fact  which  in  itself 
illustrates  the  narcotic  properties  of  the  drug.  It  is  to 
these  properties,  too,  that  alcohol  mainly  owes  its 
reputation  as  a  restorative  in  emergencies,  as,  for 
instance,  in  fainting  from  pain  or  fright:  its  value  in 
such  conditions  is  due,  not  to  any  direct  stimulation  of 
the  nervous  system  or  the  heart  by  the  drug,  but  to  its 
weakening  of  the  excessive  check  on  the  heart's  action 
exercised  by  the  nervous  centres,  and  to  its  sedative 
influence  on  the  higher  levels  of  the  brain,  relieving  pain 
and  anxiet3^  and  increasing  the  general  comfort  of  the 
patient. 

Limitations  to  value  of  alcohol  as  a  food. 
Somewhat  analogous  considerations  apply  to  the  use 
of  alcohol  as  a  food.  As  we  have  seen,  it  undoubtedly 
has  a  food  value,  when  regarded  exclusively  from  the 
point  of  view  of  its  capacity  to  act  as  a  fuel  in  the  body. 
Moreover,  alcohol  is  absorbed  very  rapidly,  and  unlike 
ordinary  food-stuffs,  it  does  not  require  to  undergo 
digestion  before  it  can  make  its  way  into  the  blood.  It 
may,  therefore,  be  useful  as  a  constituent  of  the  diet  in 
conditions  of  emergency,  as  in  acute  diseases,  when  the 
assimilation  of  ordinary  foods  is  more  or  less  interfered 
with.  But  these  advantages  are  accompanied  by  draw- 
backs which,  though  they  may  be  disregarded  in  the 
special  and  transitory  circumstances  of  an  acute  illness, 
are  amply  sufficient  to  condemn  the  use  of  alcohol  as  an 
ordinary  source  from  which  to  supply  the  energ}'  required 
by    the    body   in    health.     In   the  first    place,  alcohol   is 


129 

unsuited  for  the  latter  purpose  because  of  its  immediate 
drug  action,  which,  as  pointed  out  above,  involves,  even 
with  small  doses,  some  impairment  of  the  higher  nervous 
functions,  so  that  efficiency  is  lowered  in  all  forms  of 
work  that  demand  the  exercise  of  these  functions.  But 
quite  apart  from  this  immediately  detrimental  influence 
of  alcohol  on  the  higher  activities  of  the  brain,  there  is  a 
second  serious  limitation  of  its  utility  as  a  food.  To 
understand  this  limitation,  we  must  again  refer  to  wrhat 
we  have  already  indicated  as  an  important  point  of 
difference  between  alcohol  and  other  foods — namely,  to 
the  fact  that,  while  these  latter  foods  are  stored  in  the 
body,  in  altered  form,  to  be  drawn  upon  as  required  by 
the  muscles  and  other  parts  of  our  mechanism,  alcohol 
cannot  be  so  stored ;  it  remains  as  alcohol  in  the  blood, 
and  the  organs  generally,  until  it  is  destroyed  by 
combustion.  As  that  process  is  gradual,  the  drug,  when 
in  sufficient  amount,  can  exercise  a  seriously  injurious 
effect  upon  the  tissues  of  the  body.  If  it  is  taken 
frequently,  so  that  a  new  dose  enters  the  circulation 
before  the  previous  one  has  been  eliminated,  the  tissues 
are  seldom  free  from  this  harmful  influence,  and  the 
oathological  changes  and  disorders  follow  which  wre  have 
described  under  the  heading  of  chronic  alcoholism. 

Thus,  with  regard  to  the  use  of  alcohol  as  a  food,  we 
reach  conclusions  wdiich,  from  a  practical  point  of  viewT, 
are  substantially  consonant  with  those  to  which  we  were  led 
by  our  consideration  of  its  utility  as  a  narcotic  drug.  It 
unquestionably  is  a  food,  in  the  sense  that  it  can  be  used 
to  suppl}7  a  considerable  proportion  of  the  fuel  needs  of 
the  body,  and  it  has  even  special  properties,  due  to  the 
readiness  with  which  it  can  be  absorbed  into  the  system, 
that  may  give  it  an  added  value  in  some  conditions  of 
disease  and  convalescence ;  but  it  is  a  food  suitable  only 
for  such  emergencies.  To  use  it,  as  it  is  very  commonly 
used  by  people  who  do  not  appreciate  its  limitations  and 


130 

drawbacks,  as  a  staple  food  for  muscular  work,  is  to 
run  a  grave  risk  of  damage  to  health  and  efficiency — 
how  grave  we  have  seen  when  discussing  the  alcoholic 
mortality  of  industrial  drinkers. 

Nutritional  value  of  beer,  as  compared  ivith  other  alcoholic 

liquors. 
But  in  the  ordinary  alcoholic  beverages  there  are  other 
constituents  besides  ethyl  alcohol  :  does  their  presence 
qualify  this  conclusion  regarding  the  disadvantages  of 
alcohol  as  a  food  for  work?  In  this  country,  the  question 
arises  mainly  in  relation  to  beer,  which  contains,  in 
addition  to  alcohol,  an  appreciable  amount  of  other  sub- 
stances possessing  nutritive  value,  notably  dextrin  and 
other  carbohydrate  bodies.  It  is  generally  estimated 
that  a  pint  of  beer,  of  original  gravity  1055,  owes  rather 
more  than  half  its  food  value  to  its  contained  alcohol ; 
so  that,  regarded  as  foods,  malted  liquors,  at  all  events 
when  brewed  at  the  gravit3r  we  have  named,  are  open, 
though  in  a  smaller  measure,  to  the  objections  which 
we  have  seen  to  apply  to  the  stronger  alcoholic  bever- 
ages ;  they  cannot  be  used  as  a  large  element  in  the 
working  diet  without  danger  of  inducing  such  bodily 
disorders  as  may  be  incurred  through  the  constant  ex- 
posure of  the  tissues  to  the  action  of  alcohol.  It  is 
obvious  that,  as  alcoholic  strength  diminishes,  the  danger 
indicated  becomes  less. 

Use  of  alcohol  as  an  aid  to  work  physiologically  unsound. 

vSo  far  we  have  considered  alcohol  mainly  in  relation 
to  its  influence  on  the  working  efficiency  of  the  drinker, 
this  being,  in  fact,  the  relation  we  ordinarily  have  in 
mind  when  we  speak  of  the  food  value  of  alcohol,  or  of 
what  are  erroneously  regarded  as  its  "stimulant" 
properties.  And  we  have  found  ample  reason  to  conclude 
that  the  taking  of  alcoholic  beverages  to  promote  such 


I3i 

efficiency  is  not  only  useless  or  even  detrimental  in 
immediate  effect,  but  is  also  likely  to  be,  in  its  ultimate 
results,  seriously  injurious  to  health.  In  the  light  of  our 
knowledge  of  how  alcohol  acts  in  the  body,  there  can  be 
no  question  that  its  habitual  use  by  the  worker  as  a 
substitute  for  food  or  in  the  belief  that  it  gives  a  fillip 
to  energy,  is  physiologically  unsound. 

Conditions  under  which  use  of  alcoholic  beverages  may  be 
Physiologically  permissible. 

The  matters  summarised  in  the  preceding  paragraphs 
have  necessarily  bulked  largely  in  this  report,  and  bulk 
even  more  largely  in  popular  discussions  concerning 
alcohol.  It  must,  however,  be  said  that  among  the 
causes  that  have  contributed  to  the  world-wide  habit  of 
taking  alcohol,  its  action  as  a  food,  as  an  aid  to  digestion, 
or  as  a  supposed  cardiac  and  respiratory  stimulant,  are 
of  secondary  importance.  In  truth,  men  in  general  do 
not  drink  alcoholic  beverages  because  they  regard  them 
as  "  foods,"  nor  do  those  who  abstain  from  these  drinks 
do  so  merely  because  they  doubt  their  food-value.  The 
use  of  alcohol  is  dictated  by  the  fact  that,  to  the  majority, 
the  taste  of  alcoholic  beverages  and  the  immediate  effects 
of  alcohol  are  agreeable,  and  that  the  pleasure  derived 
therefrom  outweighs  their  estimate  of  remoter  harm,  if, 
indeed,  they  give  ulterior  considerations  any  thought  at 
all.  To  the  abstainer  either  the  taste  or  the  immediate 
effects  are  not  agreeable,  or  the  remoter  ill,  whether 
real  or  imaginary,  seems  more  important.  Each  class 
manufactures  arguments  in  favour  of  its  own  line  of 
conduct. 

So  far  as  these  arguments  have  to  do  with  the  social 
evils  which   result  from  the  excessive  use  of   alcoholic 
liquors,  they  lie   outside  the  scope  of  the  present  dis- 
cussion :  the  moral  problems  which  they  raise  cannot:  be .:■•. 
solved   by   directly   scientific   methods.      We   deal   here 

16392  k 


132 

solely  with  the  physiological  aspect  of  the  alcohol 
question,  and  our  consideration  of  this  aspect  leads  us  to 
recognise  that  the  agreeable  effects  which  the  majority  of 
people  experience  from  the  use  of  alcoholic  beverages 
can  be  produced  by  doses  of  alcohol — moderate  in 
quantity  and  taken  in  adequate  dilution  and  at  sufficient 
intervals  —  wiiich  will  not,  in  normally  constituted 
persons,  be  attended  with  appreciable  risk  to  physical  or 
mental  health.  It  is  foreign  to  the  aim  of  the  present 
statement  to  inquire  wmether  the  pleasures  associated 
with  the  moderate  use  of  alcohol  by  the  mail}'  are 
inseparably  connected  with,  or  lead  inevitably  to,  the 
evils  arising  from  its  abuse  by  the  few,  nor  is  it  relevant 
for  us  to  examine  the  effect  of  the  alcoholic  habit  on 
social  efficiency  or  national  expenditure. 

The  present  statement  is  not  concerned  with  the 
social  evils  arising  from  the  excessive  consumption  of 
alcohol  as  a  beverage  ;  nor  is  it  concerned  with  ethics, 
administration,  or  national  economy.  We  are  dealing 
solely  with  the  physiological  facts  so  far  as  it  is  possible 
to  ascertain  them  in  the  present  position  of  knowledge, 
and  within  the  prescribed  limitation  we  can  only  say  that 
the  moderate  use  of  alcoholic  beverages  is  physiologically 
permissible  only  so  long  as  it  conforms  to  the  special 
conditions  which  we  have  seen  to  be  necessary  in  order 
to  avoid  the  poison  action  of  the  drug.  The  risks  of  this 
poison  action  that  have  to  be  guarded  against  and  the 
precautions  to  meet  these  risks  may  be  summed  up  for 
practical  purposes  in  the  following  propositions: — 

(i.)  To  avoid  a  continued  action  on  the  tissues,  such  an 
interval  should  elapse  between  the  times  when  alcoholic 
beverages  are  drunk  as  will  prevent  the  persistent  presence 
of  a  deleterious  amount  of  the  drug  in  the  body. 

(ii.)  To  avoid  direct  injury  to  the  mucous  membrane  of 
the  stomach,  alcohol  should  not  be  taken  in  concentrated 
form  and  without  food. 


Ovl 


The  temperate  consumption  of  alcoholic  liquors  in 
accordance  with  these  rules  of  practice  may  be  considered 
to  be  physiologically  harmless  in  the  case  of  the  large 
majority  of  normal  adults;  and  this  conclusion,  it  may  be 
added,  is  fully  borne  out  by  the  massive  experience  of 
mankind  in  wine-drinking  and  beer-drinking  countries. 
On  the  other  hand,  it  is  certainly  true  that  alcoholic 
beverages  are  in  no  way  necessary  for  healthy  life ;  that 
they  are  harmful  or  dangerous  if  the  above-mentioned 
precautions  are  not  observed ;  and  further,  that  they  are 
definitely  injurious  for  children  and  for  most  persons  of 
unstable  nervous  system,  notably  for  those  who  have  had 
severe  injuries  of  the  head  or  who  have  suffered  from 
attacks  of  mental  disorder,  or  from  nervous  shock. 

(Signed)         D'Abernon  (Chairman'). 

George  Newman  {Vice-Chairman) . 

A.  R.  Cushny. 

H.  H.  Dale. 

M.  Greenwood. 

W.  McDougaix. 

F.  W.  Mott. 

C.  S.  Sherrington. 

W.  C.  Suuuvan. 

December,  igiy. 


APPENDIX    ] 


Total  Consumption,  and   Consumption  per  head  ok  Estimated 
Population,  of  Beer,  Spirits,  and  Wine  in  the  United  Kingdom 
in  each  Financial  Year  from  1897  to  1917. 


Total. 

Per  Head 

OF 

Population. 

Year 

end- 

ing 

Beer. 

Spirits. 

Wine. 

Beer. 

Spirits. 

Wine. 

31st 

Mar. 

Standard 
Barrels.1 

Proof 
Gallons.2 

47,927,000 

Gallons.3 

Galls.1 

Proof 
Galls.2 

Galls.3 

1897 

33,581,000 

15,810,000 

30-23 

1-20 

•40 

1898 

35,083,000 

48,279,0  0 

16,004,000 

31-28 

1-20 

•40 

1899 

35,8.i3,000 

48,550,000 

16,862,00:) 

31-66 

1-19 

•41 

1900 

36,625,000 

50,126.000 

17,147,000 

32-04 

1-22 

•42 

1901 

36,045,000 

45,403,000 

15,088,000 

31-24 

1-09 

•36 

1902 

35,442,000 

42,088,000 

14.865.000 

30-46 

1-00 

•35 

1903 

35.425,000 

43,354,000 

15,399,000 

30-18 

1-03 

•36 

1904 

34,791,U00 

42,205,000 

13,442,000 

29-39 

•99 

•32 

1905 

33,862,000 

40,109,000 

11,913,000 

28-36 

•93 

•28 

1906 

33,559,000 

39.259,000 

11,784,000 

27-70 

•90 

•27 

1907 

33,789,000 

39,847,000 

12,347.000 

27-81 

•91 

•28 

1908 

33,904,000 

39,697,000 

12,124,000 

27-66 

•90 

•27 

1909 

32,806.000 

38,940,000 

11,393,000 

26-53 

•87 

•26 

1910 

32,890,000 

26,008,000 

11,446,000 

25-96 

•58 

•25 

1911 

33,085,000 

30,888,000 

12,529,000 

26-27 

•68 

•-28 

1912 

34,362,000 

30,887,000 

11,104.000 

27-18 

•68 

•24 

1913 

34,099,00") 

30.736,000 

11,167,000 

26-86 

•67 

•24 

1914 

35,446.000 

32,596,000 

11,637,000 

27-69 

•71 

•25 

1915 

32,575,000 

34,345,000 

10,078,000 

25-60 

•75 

•22 

1916 

29,646,000 

35,597,000 

11.138,000 

23-66 

•77 

•25 

1917 

25,923,000 

23.996.000 

8,929,000 

21-49 

•52 

•20 

1  A  "  standard  barrel  "  represents  36  gallons  of  beer  of  an  "original 
gravity"  of  1055  (water  taken  as  1000)  and  is  the  unit  on  which  taxa- 
tion is  based.  By  ''original  gravity"  is  meant  the  specific  gravity  of 
the  worts,  before  fermentation,  from  which  beer  is  brewed.  As  beer 
is  brewed  on  the  average  lighter  than  the  standard,  the  number  of 
actual  "bulk"  or  "liquid  barrels"  annually  consumed  is  higher 
than  the  corresponding  number  of  standard  barrels  given  in  the 
Excise  returns.  In  column  5,  a  "gallon"  of  beer  means  £w  of  a 
standard  barrel. 

2  A  "  Proof  gallon  "  is  a  gallon  of  "  Proof  Spirit,"  in  terms  of  which 
the  strength  of  distilled  spirits  is  usually  expressed  in  this  country. 
Proof  Spirit  is  a  mixture  of  alcohol  and  water  having,  at  a  tempera- 
ture of  60°  F..  a  specific  gravity  of  "91976,  compared  with  water  taken 
as  unity.  The  mixture  contains  49*28%  of  alcohol  by  weight  and 
57*10%  by  volume. 

3  The  figures  referring  to  the  consumption  of  wine  indicate  gallons 
irrespective  of  alcoholic  strength,  which,  of  course,  varies  very  widely 
in  the  case  of  different  wines. 


APPENDIX    2. 

Annual  Death  Rates  (England  and  Wales), 

from  (a)  Alcoholism,   and  (b)    Cirrhosis  of  the   Liver  at 

all  Ages  to  a  Million  Living  from   1891  to  1916. 


Years. 

Alcoholism. 

Cirrhosis  of  the  Liver. 

Males  and 
Females. 

Males. 

Females. 

Males  and 
Females; 

Males. 

Females. 

1891 

71 

94 

49 

125 

148 

104 

1892 

67 

86 

49 

122 

142 

104 

1893 

73 

93 

55 

120 

139 

103 

1894 

61 

76 

47 

115 

136 

96 

1895 

67 

84 

51 

118 

133      104 

1896 

71 

91 

52 

122 

140      106 

1897 

77 

97 

58 

133 

151      115 

1898 

78 

98 

59 

132 

152      112 

1899 

90 

113 

69 

142 

167      119 

1900 

113 

132 

95 

144 

162      127 

1901 

96 

113 

80 

132 

151      115 

1902 

84 

105 

65 

123 

144 

104 

1903 

77 

92 

63 

118 

136 

100 

1904 

70 

86 

55 

118 

135 

101 

1905 

65 

79 

52 

118 

132 

105 

1906 

66 

81 

53 

112 

127      98 

1907 

63 

79 

49 

112 

123      102 

1908 

55 

65 

45 

104 

121 

89 

19i)9 

47 

68 

37 

100 

120 

81 

1910 

42 

50 

34 

90 

106 

75 

1911 

45 

57 

34 

91 

105 

78 

1912 

45 

55 

36 

93 

108 

79 

1913 

52 

62 

42 

97 

115 

80 

1914 

53 

64 

43 

99 

117 

82 

19151 

43 

53 

35 

93 

120 

70 

19161 

29 

40 

21 

79 

111 

54 

1 

The  material  for  this  Table  has  been  obtained  from  the  Annual 
Reports  of  the  Registrar  General,  and  from  information  supplied 
by  Dr.  T.  H.  C.  Stevenson,  Superintendent  of  Statistics  at  Somerset 
House. 


1  Based  upon  Civil  deaths  and  Civil  population. 


APPENDIX  9. 


Comparative  Mortality  of  Males  Aged  25-65  Years  in  the 
Chief  Occupational  Groups  (England  and  Wales)  (a)  from 
Alcoholism,   (b)   from  Alcoholism    and    Liver   Diseases  taken 

TOGETHER,  AND  (c)  FROM    ALL    CAUSES,  IN    THE    PERIOD    1910-1912. 

NOTE. — The  "comparative  mortality"  figure  from  any  given 
disease  in  any  given  occupation  indicates  the  number  of  deaths  from 
that  disease  which  would  occur  in  a  population  corresponding  in 
numbers  and  in  age  constitution  with  the  standard  population,  but 
composed  solely  of  persons  engaged  in  the  particular  occupation  in 
question.  In  this  table  the  ''standard  population  "  is  the  population  of 
males,  aged  from  25  to  65  years,  which  in  the  period  1900-1902 
furnished  1000  deaths  from  all  causes. 


1 

;i910-1912.) 

Group. 

Alcoholism. 

Alcoholism  & 
Liver  Diseases. 

All 
causes. 

All  Males           

7 

23 

790 

Clergyman,  Priest  &  Minister' 

2 

11 

443 

Railway       Engine       Driver. 

2 

11 

586 

Guard,  Porter,  etc. 

Platelayer,  Railway  Labourer 
Agriculturists   ... 

2 
3 

11 
11 

623 
474 

Coal  Miner       ...         

3 

13 

727 

Shipbuilding    ... 
Printers            

5 
5 

12 
14 

633 
773 

Building  Trade 

5 

17 

726 

Metal  Workers            

5 

19 

804 

Shoemaker 

6 

17 

820 

Textile  Manufacturer 

6 

19 

799 

Commercial  Clerk,  Insurance 

6 

22 

802 

Agent. 
Ta.lor 

6 

22 

799 

Baker 

n 
i 

19 

664 

Carmen,  Carriers        

7 

21 

900 

Shopkeepers     ... 
Commercial  Traveller 

8 
9 

27 
32 

683 
724 

Medical  Profession1    ... 

9 

38 

693 

Coach,  Cab,  Bus         

12 

29 

921 

Messenger,  Potter 

13 

33 

1,137 

Barrister.  Solicitor1 

13 

39 

627 

Seaman  and  Merchant  Service 

18 

34 

1,485 

Butcher             

18 

56 

*85 

General  Labourer 

20 

50 

2.801 

Dock  Labourer 

26 

43 

1.127 

Costers,  Hawkers 

30 

52 

1.507 

Publican,  Innkeeper,  etc. 

50 

152 

1,265 

For  the  above  Table  the  Advisory  Committee  are  indebted  to  Dr. 
T.  H.  C.  Stevenson.  Superintendent  of  Statistics  at  Somerset  House 
1  Based  on  relatively  small  numbers. 


APPENDIX  4. 


Percentage  of 

Proof  Spirit  and  of 

Absolute  Alcohol 

in  Various  Beverages. 

Original 

Percentage 

of  Proof 

Spirit. 

Percentage 
of  Absolute 

Percentage 
of  Absolute 

Gravity.1 

Alcohol3 
(by  weight). 

Alcohol2 
(by  volume). 

bPIRITS — 

At  25°  up. 

— 

75-0 

35-9 

42-8 

At  30°  up. 

— 

70-0 

33-3 

40-0 

At  35°  u.p. 

— 

65-0 

30-8 

371 

At  4  °u.p. 

— 

60-0 

28-3 

34  3 

At  50°  u.p. 

— 

50-0 

23*4 

28-6 

Wines — 

Port         

— 

35.3 

16-4 

20-2 

Sherry    ... 

— 

29-5 

13-7 

16-9 

Madeira  ... 

— 

28-9 

13-4 

16-5 

Tarragona 

— 

27  2 

12-6 

155 

Australian       Bur- 

— 

24-8 

11-5 

142 

gundy 

Italian  Red  Wine 

— 

23-9 

111 

13-7 

Champagne 

— 

23-6 

109 

13  5 

French  Burgundy 

— 

22-1 

10-2 

12-6 

(red) 

Californian     Bur- 

— 

20-8 

96 

11-9 

gundy 

Italian  VVhiteWine 

— 

20-6 

.     95 

11-8 

French  Burgundy 

— 

20-2 

9-3 

11-6 

(white) 

Bordeaux  (white) 

— 

19-9 

9-1 

11-4 

(red) 

— 

17-0 

7-8 

9-7 

Cider  (bottled)   ... 

— 

7-4 

3-4 

4-2 

Beers  (English)  - 

Pale  or  Bitter  Ale 

1060-2 

111 

5-1 

6  4 

London  Stout    ... 

1064-6 

97 

4-4 

55 

Burton  Ale 

1053-2 

9-4 

4-3 

5-4 

Light  Pale  Ale  ... 

1042-6 

79 

36 

4-5 

Mild  Ale  (No.  1) 

1037-8 

5-8 

2-6 

.      33 

Porter     

1041-5 

4-3 

1-9 

2-4 

Mild  Ale  (No.  2) 

1016-5 

2-8 

1-3 

1-6 

Beers  (Import) — 

Dutch  (1916)     ... 

1053-5 

9-S 

4-5 

5-6 

Danish  (1916)  ... 

1057-6 

8-8 

4-0 

5-0 

Norwegian  (191 6) 

1042-4 

6-8 

3-1 

3-9 

Pilsener       Lager 

10540 

9-4 

4-3 

5-4 

(Pre-war) 

Munich        Lager 

1057-0 

8-8 

4-0 

5-0 

(Pre-war) 

The  determination  of  the  alcoholic  strengths  of  wines,  beers  and 
cider  for  the  purpose  of  this  Table  has  been  made  at  the  Government 
Laboratory  under  the  direction  of  Mr.  E.  Grant  Hooper,  F.I.C.,  the 
Deputy  Government  Chemist,  from  samples  of  the  several  beverages 
purchased  in  London.  The  wines  represent  the  cheaper  brands 
retailed  by  grocers.  As  regards  the  strength  of  English  beers,  it 
should  be  remembered  that  the  examples  given  above  represent  pur- 
chases made  at  the  end  of  1917.  Before  the  war  current  strengths 
were  appreciably  higher. 

1  See  footnote  to  Appendix  1. 
2  From  Thorpe's  Alcnholometric  Tables  :  London,  1915. 


APPENDIX  5. 


Amount  of  Proof  Spirit  and  of  Absolute  Alcohol  (by  volume) 
in  usual  Retail  Measures  of  the  ordinary  Alcoholic 

Beverages. 

Note  on  Retail  Measures. — Beer,  wine  or  spirits  sold  by  the 
"  glass  "  may  be  supplied  in  any  unstamped  vessel,  and  there  is  no  legal 
obligation  as  to  the  quantity  of  fluid  which  a  glass  of  any  of  these 
beverages  should  contain.  In  practice  a  glass  of  beer  usually  contains 
5  of  a  quart,  i.e.  a  little  less  than  \  pint,  and  it  may  contain  only 
|  quart.  In  the  case  of  spirits,  a  "  glass "  of  whisky,  more  often 
described  in  the  South  as  a  i-  large  whisky,"  contains  generally  from 
I  to  \  gill  ;  a   small  glass  contains  \  gill,  or  sometimes  as  little  as 

|  gill. 

The  "  glass  "  of  wine  is  also  a  very  variable  quantity,  ranging  from 
?  of  a  gill  to  about  f  gill  ;  the  latter  being  the  average  capacity  of  the 
dock  glass  in  which  port  is  ordinarily  sold  at  the  bar. 


Absolute  Alcohol. 

Proof  Spirit. 
Fluid  ounces. 

Fluid 

Cubic 

ounces. 

Centimetres 

BEERS. 

Light  Pale  Ale 

(original  gravity 

1042-6) 

1  pint 

1-58 

•90 

25-6 

\  pint 

•79 

•45 

12-8 

glass  (|  pint) 

•63 

•36 

10-2 

Mild  Ale 

(original  gravity 

1037-0) 

1  pint 

l-Jfi 

•66 

18-6 

£  pint 

•58 

•33 

9-3 

glass  (|  pint) 

•46 

•26 

7-4 

WINES. 

Claret,  \  pint            

1-70 

•97 

27-6 

Sherry,  glass  Q  gill) 

•74 

•42 

11*9 

Port,  dock  glass  (f  gill)      ... 

1-32 

•75 

2P3 

SPIRITS— 

at  30°  u.p. 

Large  glass  (£  gill) 

1-73 

POO 

2S 

Small  glass  (£  gill) 

•70 

•40 

IP 

at  50°  u.p. 

- 

Large  glass  Q  gill) 

1-25 

•71 

20-1  ' 

Small  glass  [\  gill) 

•50 

•28 

8-0 

INDEX. 


Absorption  of  alcohol  from  alimentary  canal 

,,  of  food  

Abstinence,  delirium  tremens  not  due  to       

„  symptoms  in  drunkards ...         

,,  „  in  morphine  takers 

Accessory  substances      

Alcohol,  definition  of      

,,       not  stored  in  body  in  altered  form 
Alcoholic  beverages,  alleged  differences  in  effects  of  several 
,,  „  consumption  of,  statistics  of      Appendix 

„  ,,  impurities  in     ...         ...         

,,  „  retail  measures  of        Appendix 

„  „  strength  of         Appendix 

„  poisoning,  amount  of  fatal  dose  in 

,,  „  cause  of  death  in 

Alcoholism,  chronic        

„  „        causation  of 

,,  experimental 

,,  parental,  effects  of  

Alveolar  air  

Arterial  blood-pressure 

.,            ,,          ,.        effect  of  alcohol  on 
Atwater  and  Benedict 


Page 
17 
61 

,  11? 

,  112 

,  112 
8 
2 

.12,21 
89 


Beer,  nutritional  value  of  

„      strength  of 

Benedict,  see  Atwater  and  Dodge. 

Bile  

Blood,  concentration  of  alcohol  in 

„      vessels,  superficial,  dilated  by  alcohol 

Carbohydrates      ...  

„  substitution  of  alcohol  for 

Carminative  action  of  alcohol 

Circulation  of  blood        ...         ...         

Carlson 

Carbon  dioxide 

„  „       in  alveolar  air 

„  .,       stimulates  respiratory  centre 


Appendix 
20, 


.  88 
70,  86 

,  94 

.*  104 

.  96 

.  103 

.  68 

.  71 

.  75 

.  23 

.  130 


.  58 
87,  88 
72,  81 

9 
.  24 
.  59 
.  71 
.   58 


68 
67 


vii 

Page 
Carbonic  acid,  sec  Carbon  dioxide. 

Chauveau ...  49 

Chittenden            58 

Cirrhosis  of  liver ...         ...         ...         ...         ...         ...         ...         ...  99 

Cold,  effect  of  exposure  to         80 

,,          „      .,   on  circulation ...         ...         ...         ...  80 

,,       sensation  of,  dulled  by  alcohol            ...         ...         ...         ...  82 

„       use  of  alcohol  in  exposure  to   ...         ...         ...         ...         ...  83 

Concentrated  alcoholic  liquors,  dangers  of...           ...         ...          99,  106 

Consumption  of  alcoholic  beverages,  statistics  of  ...    Appendix  1 

Craving,  alcoholic          109 

Delirium  tremens           ...         ...         ..          ...         ...         97 

„              „        not  an  abstinence  symptom         ...         ...         ...  112 

Digestion,  action  of  alcohol  on            .           ...         ...         ...         ...  56 

„  effects  of  different  alcoholic  beverages  on  ...  59,62 

„          effect  of  mental  state  on     ...         ...         ...         ...         60,  128 

„          factors  in  process  of            ...         ...         ...  56 

Digestive  system  in  chronic  alcoholism         ...         ...  99 

Dilution,  advantages  of  ...         ...         ...         ...         ...         ...         ...  90 

„        effect  of,  on  action  of  alcohol          89 

Dipsomania          98 

Distillation           ... 3 

Dock  labourers,  mortality  of,  from  alcoholism         107 

Dodge  and  Benedict       44,  45,  52 

Drug,  definition  of          ...         ...         ...         13 

„       action  not  necessarily  harmful 14 

„       habit           109 

Drunkenness,  emotional  instability  in           34 

,,            loss  of  control  in           ...         ...         ...         ...         ...  35 

.,            pathological        ...         ...  93 

,,            alcohol  content  of  blood  in      87 

,,            stages  of ...  31 

„            variety  of  mental  symptoms    in         ...         38 

Durig          49 

Energy  of  body,  how  obtained 7 

Ergograph,  experiments  with ...         ...         ...         ...  46 

Ethers,  in  wines  and  spirits     ...         ...         ...         ...         ...         ...  62 

Eye-closing  reflex,  influence  of  alcohol  on 44 

Eye  movements,  effect  of  alcohol  on  accuracy  of ...  51 

Excretion,  definition  of...           ...  18 

,,          of  alcohol,  conditions  affecting     ...         ...         ...         ...  19 

,,           „       ,,          in  breath  and  urine     ...         ...         ....         ...  10 

„       ,,          in  sweat ...         ...  19 


Vlll 

Page 

Fainting,  use  of  alcohol  in        128 

Fats            9 

,,     replacement  of  by  alcohol          24 

Fermentation       3 

Fermented  liquors,  constituents  of      ... 3 

Ferments,  digestive        ...         ...         ...  59 

Food,  definition  of  6,  9 

Foods,  several  classes  of           ...         ...         ...        ...  9 

„       use  of .  to  repair  body  tissue 10 

Food-stuffs,  physiological  classification  of ...  11 

„        ,,       replacement  of,  by  alcohol         ...         ...         ...         ...  24 

Food-value  of  alcohol ... 23 

„        ,,       ,,        ,,        limitations  on 28 

Food,  disadvantages  of  alcohol  as  a  ...         128 

Friendly  Societies,  sickness  rates  .of 122 

Fusel  oil    ...         ...         ...         ...  3 

Glycogen .......  10 

Grehant     ... ...         ...  20 

Guillery 52 

Habit-forming  influence  of  alcohol 98,  109 

Heart,  action  of,  controlled  by  nervous  system       ...         ...        :.'.  73 

„        „        „    depressed  by  large  doses  of  alcohol        ...        .:.  75 

,,        ,,        ,,    indirectly  excited  by  alcohol ...  76 

„     isolated,  action  of  alcohol  on ...         ...  74 

Heat-regulating  centre . ...  79 

Hellsten ...  .  48 

Hill-climbing,  effect  of  alcohol  in       49 

Infective  disease,  decreased  resistance  of  alcoholics  to     101 

Insanity,  relation  of  alcoholism  to       97 

Intervals  between  drinking,  importance  of ..        108,  132 

Knee-jerk,  influence  of  alcohol  on       45 

Kraepelin  ...         ...         ...         ...         ...         ..  ...  ••  38,  48 

Lactation,  see  Milk. 

Life  Insurance  statistics ...         ...  116 

Liquor  Trade,  mortality  of  persons  engaged  in       ...         ...        121,  124 

Liver,  cirrhosis  of           ...         ...         99 

„  „  mortality  from       Appendix  2 

Longevity  of  abstainers        ...         ... 116 

Mental  effects  of  alcohol                      30 

Metabolism,  definition  of           12 


IX 


Milk,  effect  of  alcohol  on  secretion  of 

„.   excretion  of  alcohol  in 

Miners,  low  alcoholic  mortality  of 
Mixing  of  liquors 
Morphine,  tolerance  of  ... 

„  habit  ...         

„  ,,     abstinence  symptoms  in 

Mortality  from  alcoholic  disease  

Movements,  skilled,  effect  of  alcohol  on 

,,           of  stomach,  effect  of  alcohol  on 
Muscles  not  directly  affected  by  alcohol 
Muscular  acts,  action  of  alcohol  on     

Narcotic,  alcohol  a  ...         .„         , 

„        action,  when  beneficial        

Nervous  system  in  chronic  alcoholism 
Nervous  system,  action  of  alcohol  mainly  on 
Nutrition,  no  special  action  of  alcohol  on 


Page 

19 

13 

107 

90 

92    11] 

Ill 

...     112 
Appendices  2  and  3 

46,  50 

58 

...   41 

41 


38,  125 
...  127 
..  98 
125 
26 


Occupation,  in  relation  to  use  of  alcohol       

Occupational  groups,  mortality  from  alcoholism  in 

Oseretzkowsky 

Oxidation,  definition  of 

„        of  alcohol  in  body 

Pancreatic  secretion       

„        ferment  

Poison  action,  defined    ...         ...         ...         

„  „        of  alcohol  

Poisoning,  acute  and  chronic    ... 
Precautions  in  use  of  alcoholic  beverages     ... 

Proof  spirit,  definition  of  

Proteins      

„      sparing  of,  by  alcohol 
Pulse,  effect  of  alcohol  on         ...         

,,      reflex  quickening  of 


Appendix 


Reflex  acts 


effect  of  alcohol  on 


Reproductive  cells,  action  of  alcohol  on 

Respiration  ...         ...         

Respiratory  activity,  indirect  effect  of  alcoholon  '.. 

„  centre  

.,  „     .  alleged  stimulation  of,  .by  alcohol 

,,  .,       paralysis  of,  in  alcoholic  poisoning 


... 

.. 

48 

. 

-* 

7 
21 

58 

•       •  •• 

■ .. 

60 
15 
85 



15 

,  85 
132 

.  Appendix 

1 

9 
24 
72 

f         ... 

... 

73 

42 
43 

101 
64 
65 

64 

..... 

67 

ig   ... 

70 

86 

108 


3 


Respiratory  Quotient      

Rivers         

Rum  ration  in  Army       

Saccharin,  excreted  unchanged 

Saliva         

Self-criticism,  blunted  by  alcohol 

Shivering 

Spirit-drinking,  in  relation  to  chronic  alcoholism 
„  „  „  drunkenness   ... 

Stimulant,  alcohol  not  a  

Stockard ...         .v 

Stomach,  catarrh  of,  in  drunkards      

Susceptibility  to  alcohol,  differences   in 

„                    ,,                    „               in  animals 
„  „  morbid        

Synapses,  probable  action  of  alcohol  on 

Temperature  of  body 

„  „         how  maintained 

„  „         effect  of  alcohol  on     ... 

„  „         regulation  of    

Tolerance  of  alcohol       

„  „  not  acquired  by  all  body  cells 

Venereal  disease,  in  relation  to  alcohol 
Volitional  acts,  complexity  of 

Well-being,  feeling  of,  induced  by  alcohol    ... 

Will,  enfeeblement  of,  in  alcoholics 

Wines,  effect  of,  on  digestive  ferments 

„      strength  of  

Work,  alcohol  unsuitable  as  food  for 

„      skilled,  effect  of  alcohol  on       


Page 

22 

47,  50,  .51 

127 

18 

56 

33 

.80 

106 

105 

31,37,77,  125 

103 

99 

91 

97 

93 

36 

78 
79 
81 
80 
91 
..       92 

95 

46 

30 

...     113 
59 

Appendix  4 

...     129 
126,  129 


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His  Majesty's  Stationery  Office 

by 

Darling  &  Son.  Ltd..  Bacon  Street,  London,  E.  2, 


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